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									Vermont Academic Detailing Program
•   Charles MacLean MD
•   Amanda Kennedy PharmD, BCPS
•   Richard Pinckney MD, MPH
•   University of Vermont College of Medicine
     • Office of Primary Care and Area Health
       Education Centers

• February 11, 2008
• Contact information
   • charles.maclean@vtmednet.org
   • amanda.kennedy@vtmednet.org
   • richard.pinckney@vtmednet.org

          Vermont Academic Detailing Program
                                                1
                             Outline

•   History
•   Logistics
•   How our program may differ
•   Challenges
•   Questions




               Vermont Academic Detailing Program
                                                    2
                             History

• 1999: Established by a PharmD-MD team
  • Began as a formulary management tool for
    BlueCross BlueShield
  • Additional support from UVM-AHEC, Community
    Health Foundation
• 2004: Amanda Kennedy and Rich Pinckney
  hired to co-direct program
• 2007: Vermont Legislature supports expansion
  • Charles MacLean
  • Act 80: Increasing Transparency of Prescription
    Drug Pricing and Information www.leg.state.vt.us

               Vermont Academic Detailing Program
                                                       3
          Overview of Current Program
• AD Team
  • One MD / One PharmD
• ~25 visits per year
  • mostly scheduled noontime sessions
• Content development
  • 1 new module per year
  • ~100 hours development per module
• Group Detailing Module
  • Providers, nursing, other staff invited to attend
• Training program
  • New for 2008

                Vermont Academic Detailing Program
                                                        4
          Vermont Primary Care Practices
• Geography
• Providers
  • 385 FP and IM providers
  • 48/192 practices visited
• Travel Burden
  • Median round-trip driving
    distance 93 miles per session
    (range 0-342 miles)
  • Median time commitment of
    3.5 hours per academic
    detailer per session (range 1-
    7.25 hours)

                 Vermont Academic Detailing Program
                                                      5
               Prescriber Incentives

• Epocrates Pro gift certificate ($60 value)
• Breakfast or lunch
• CE credits planned for 2008




               Vermont Academic Detailing Program
                                                    6
            Group Detailing vs 1:1 Sessions
• Advantages
  • Opportunity to have partners share their prescribing preferences—
    peers are a strong influence
  • Time for a comprehensive overview of topic
  • Opportunity for a change to office microsystem
  • Many practices have time set aside
  • Efficiency when traveling long distances
• Disadvantages
  • Don’t need this long a session for a more focused learning objective
  • Unknown effect on the social marketing relationship
  • Fewer visit opportunities because of scheduling




                     Vermont Academic Detailing Program
                                                                           7
                  Antibiotic prescribing
• Based on CDC Get Smart Program
• Format:
  • AD sessions with 9 practices
  • Office microsystems approach
     • Wall posters
     • Patient handout during rooming
     • Viral prescription pad
• Formula for success
  • Long-standing consensus
  • Readiness and awareness
  • Thirst for implementation strategies


                  Vermont Academic Detailing Program
                                                       8
            Challenges for AD programs

•   Travel burden
•   Financial support and sustainability
•   Keeping content up to date
•   High demand
•   Evaluation




                Vermont Academic Detailing Program
                                                     9
       Are there creative ways to deliver content
           at a distance or asynchronously?
• Telephone and web support—Kennedy et al
   • Initial face-to-face meetings
   • 1 year telephone and web support
   • Goal: 400 providers in VT, ME, PA
• University educational platform (Blackboard)




Do we need multiple formats for different learning styles?
                 Vermont Academic Detailing Program
                                                             10
                    Questions
• What is the importance of the relationship?
  • How often, how long, how much content?
• How do we share content among programs?
• PCP vs speciality audiences
• Consumer audiences
  • PWP program
• Any experience with vouchers?




              Vermont Academic Detailing Program
                                                   11
                     Topics of interest
Topic                                           Proportion
                                        (82 from 219 respondents)
Diabetes (general, new agents)                        23
CVD (HTN, dyslipidemia, other)                        20
Mental Health                                         17
Asthma & COPD                                         9
Marketing & policy issues                             6
Antibiotic prescribing (MRSA)                         5
Pain & pain modulators                                5
GI (PPIs, IBD)                                        4
OCPs                                                  4
Reading the literature                                2
Headache/Migraine                                     2
Hypnotics                                             2
Neuro (Alzheimers)                                    1
Total                                             100%

                 Vermont Academic Detailing Program
                                                                    12

								
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