Evaluation of academic detailing to educate clinicians regarding childhood lead poisoning prevention: a pilot study

Abstract Context Environmental exposures are associated with approximately 19% of disease globally, and exposure to neurotoxic chemicals is estimated to cost the United States $50 billion per year. Despite calls from the Institute of Medicine to increase training for clinicians regarding environmental health since the 1990s, there is still little instruction in environmental health for clinicians. This leaves gaps in knowledge that need to be bridged through outreach and education to practicing clinicians. Academic detailing (AD) is an educational intervention associated with improved prescribing practices in healthcare professionals but has not been applied to preventive or environmental health. Childhood lead exposure is a common condition associated with lifetime increased risk of cognitive and behavioral problems. Ohio has more than 2 million homes built before 1978, making exposure to lead-based paint a significant public health problem; however, only 50% of high-risk children are tested for lead. Few receive health promotion information regarding lead poisoning prevention, in part because this is not a part of training for healthcare providers (HCPs). Objectives The objectives of this study were twofold: (1) implement a pilot of AD sessions on the topic of childhood lead poisoning prevention with frontline HCPs and their staff in different practice settings; and (2) evaluate the acceptability of these training sessions utilizing quantitative and qualitative methods. Methods Physicians, nurses, social workers, community health workers, and clinical office staff were recruited from clinics who care for children at high risk for lead exposure. Trainings consisting of small group AD style sessions were presented at these sites. Learning objectives included increasing knowledge regarding lead testing requirements, enabling identification of lead’s impact on child development and equipping participants to provide anticipatory guidance for parents regarding lead poisoning prevention. Participants provided feedback through an anonymous questionnaire and qualitative feedback. Results There were 46 participants (12 physicians in practice/in training, 21 nursing or office staff, and 13 community health or social workers); more than 90% of the participants reported that the training achieved its learning objectives. Small-group presentations were preferred (91%); approximately 39% of participants requested an online format. Participants preferred that the presenters be either a public health or lead clinical expert, and they suggested that future activities include clinical vignettes. Conclusions Academic-detailing style training shows promise in promoting childhood lead poisoning prevention for frontline HCPs.

[1]  P. Sheffield,et al.  Children's environmental health and disaster resilience in Puerto Rico and the U.S. Virgin Islands. , 2021, Applied nursing research : ANR.

[2]  L. Trasande,et al.  Trends in neurodevelopmental disability burden due to early life chemical exposure in the USA from 2001 to 2016: A population-based disease burden and cost analysis , 2019, Molecular and Cellular Endocrinology.

[3]  Courtney M. Brown,et al.  Standardizing Clinical Response to Results of Lead Screening: A Quality Improvement Study , 2019, Pediatrics.

[4]  A. Woolf,et al.  Building Capacity in Pediatric Environmental Health: The Academic Pediatric Association's Professional Development Program. , 2019, Academic pediatrics.

[5]  Joanna Smith,et al.  Interpretive phenomenological analysis applied to healthcare research , 2018, Evidence Based Journals.

[6]  G. King,et al.  Assessing Child Lead Poisoning Case Ascertainment in the US, 1999–2010 , 2017, Pediatrics.

[7]  James R. Roberts,et al.  Integrating Environmental Management of Asthma into Pediatric Health Care , 2016, Clinical pediatrics.

[8]  H. Brumberg,et al.  Prevention of Childhood Lead Toxicity , 2020, Pediatrics.

[9]  K. Larson,et al.  Public health detailing of primary care providers: New York City's experience, 2003-2010. , 2012, American journal of preventive medicine.

[10]  K. Gehle,et al.  Integrating environmental health into medical education. , 2011, American journal of preventive medicine.

[11]  L. Trasande,et al.  Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008. , 2011, Health affairs.

[12]  J. Carney,et al.  Barriers to Pediatric Lead Screening: Implications From a Web-Based Survey of Vermont Pediatricians , 2010, Clinical pediatrics.

[13]  L. Frisch,et al.  Cost of Child Lead Poisoning to Taxpayers in Mahoning County, Ohio , 2005, Public health reports.

[14]  James R. Roberts,et al.  Incorporating Environmental Health into Pediatric Medical and Nursing Education , 2004, Environmental health perspectives.

[15]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.

[16]  R. Grol,et al.  Practice visits as a tool in quality improvement: mutual visits and feedback by peers compared with visits and feedback by non-physician observers. , 1999, Quality in Health Care.

[17]  A D Oxman,et al.  Changing physician performance. A systematic review of the effect of continuing medical education strategies. , 1995, JAMA.

[18]  S B Soumerai,et al.  Principles of educational outreach ('academic detailing') to improve clinical decision making. , 1990, JAMA.

[19]  A. Woolf,et al.  Pediatric Environmental Health Specialty Units: An Analysis of Operations. , 2016, Academic pediatrics.

[20]  L. Trasande,et al.  Translating knowledge about environmental health to practitioners: are we doing enough? , 2010, The Mount Sinai journal of medicine, New York.