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Academic Detailing (AD): A New Resource From AR-IMPACT

Learn about academic detailing and its relevance to prescribing opioid medications. Discover the effectiveness of this outreach technique in promoting evidence-based care. Join the AR-IMPACT-AD Program and decrease high-risk opioid prescribing while increasing the use of alternative pain management strategies.

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Academic Detailing (AD): A New Resource From AR-IMPACT

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  1. Academic Detailing (AD): A New Resource From AR-IMPACT Teresa Hudson, PharmD, PhD Associate Professor, Department of Psychiatry CE Credits: TEXT: 501-406-0076  Activity Code:30083-24581

  2. Set Up for Using Poll Everywhere • Text to this number: 22333 • Text this message: Teresahudson735

  3. Goals of AR IMPACT-AD Program • Decrease high-risk prescribing of opioids • Daily dose >50 MME • Prescribing for longer than 3-7 days • Prescribing to patients with history of SUD • Increase use of other pain management strategies • NSAID/Acetaminophen • Other medications for neuropathic pain • Physical therapy • Exercise: walking, stretching, etc.

  4. Presentation Objectives: • After attending this presentations, participants will be able to: • Define academic detailing and understand how this strategy is relevant to prescribing opioid medications • Discuss evidence for effectiveness of academic detailing • Understand the implementation of academic detailing as a resource from AR-IMPACT

  5. What is Academic Detailing (AD)? • An innovative, 1-on-1 outreach education technique that helps clinicians provide evidence-based care to their patients. • Gerry Avorn, MD • Patterned after detailing visits used by pharmaceutical industry • Focus is on evidence for a particular treatment • AD visits may also focus on lack of evidence for a particular treatment • During visit, implementation of evidence-based treatments to replace non-evidence based treatment are discussed

  6. Description of Academic Detailing Visit • Short one-on-one meeting between detailer and prescribers • Usually 10-20 minutes • Focus on 1-3 messages around a particular topic. • For example, how to wean opioids and use of non-opioid analgesics • Can be tailored to the patient population of that prescriber • Often Delivered by a pharmacist • Many programs use a range of healthcare professionals along with health educators • Usually involves some written materials that may be retained by the prescriber

  7. Effectiveness of Academic Detailing • Widely used by VA to: • Decrease high dose antipsychotic • Decrease antipsychotic polypharmacy • Decrease high risk opioid prescribing • Increase CPT for PTSD • Other studies have shown AD to be effective in: • Increasing pneumococcal vaccination – (Caffrey et al 2017) • Increased use of NSAIDs for pain – (Bruyndoncks et al 2018) • Decreasing use of cerebral and peripheral vasodilators, oral cephalosporin antibiotics, and propoxyphene (Avorn and Soumerai 1983)

  8. Why AR IMPACT is Offering AD: • https://www.cdc.gov/drugoverdose/maps/rxstate2017.html • National average for rate of opioid prescribing is 79.3 opioid prescriptions per 100 persons • Arkansas’ current rate of opioid prescribing is 102-111/100 persons • 66/75 Arkansas counties have rate higher than national average • 86% of heroin users report previous use of prescription opioids • Sources: family, friends, personal prescriptions

  9. Opioid Overdose Deaths

  10. Arkansans are at risk for Chronic Pain:

  11. Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2017 • ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be • compared to prevalence estimates before 2011. • *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

  12. AR IMPACT-AD Program • Funded through grant from CDC to Arkansas Dept. of Health • Subcontract to UAMS – AR IMPACT team • Timeframe: expected to end September 30, 2019 • Team: • AR IMPACT team – review all AD materials • AR IMPACT Pain Specialist available for one-on-one consultation • Emergency Department Physician available for one-on-one consultation • Primary Academic Detailer: Armenda Young, PharmD • Project Manager: Amanda Lunsford, MA

  13. AR IMPACT-AD Program Features: • Materials/messages focused common opioid prescribing problems: • Tapering strategies for opioids • Non-opioid analgesic medications for pain • Non pharmacotherapy options for pain • Communicating with patients about pain • PDMP data used to identify prescribers who prescribe: • High MME daily dose • High number of pills for chronic use • Have large number of patients receiving opioids

  14. AR IMPACT-AD Program Features: • Make appointment with prescriber at their convenience • Visit in person to talk about challenges in pain management • Discuss materials/messages relevant to that prescriber • Prescribers will have the opportunity to give feedback on visit • Suggest other topics • Request visits if needed

  15. Evaluating AR IMPACT–AD Program • Short email survey to prescribers who receive AD visit • Evaluation of change in prescribing practices • Tracking outcome of visits • Tracking requests for additional visits on specific topics • Roll-out in “step-wise” fashion to compare prescribing rates at places who did and did not receive AD.

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