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Nazari JL, Kulbokas V, Smart MH, Hensle TR, Lee TA, Pickard AS. Implementation of virtual academic detailing in North America: A qualitative study. J Eval Clin Pract 2024; 30:693-702. [PMID: 38652541 DOI: 10.1111/jep.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE The shift toward virtual academic detailing (AD) was accelerated by the COVID-19 pandemic. AIMS AND OBJECTIVES We aimed to examine the role of external, contextual, and intrinsic programme-specific factors in virtual engagement of healthcare providers (HCPs) and delivery of AD. METHODS AD groups throughout North America were contacted to participate in semistructured interviews. An interview guide was constructed by adapting the Consolidated Framework for Implementation Research (CFIR). A point of emphasis included strategies AD groups employed for provider engagement while implementing virtual AD programmes. Independent coders conducted qualitative analysis using the framework method. RESULTS Fifteen AD groups from Canada (n = 3) and the United States (n = 12) participated. Technological issues and training detailers and HCPs were challenges during the transition to virtual AD visits. Restrictions on in-person activities during the pandemic created difficulties engaging HCPs and fewer AD visits. Continuing education was one strategy to incentivize participation, but credits were often not claimed by HCPs. Groups with established networks and prior experience with virtual AD leveraged connections to mitigate disruptions and continue AD visits. Other facilitators included emphasizing contemporary topics, including opioid education beyond fundamental guidelines. Virtual AD had the additional benefit of expanding geographic reach and flexible scheduling with providers. CONCLUSIONS AD groups across North America have shifted to virtual outreach and delivery strategies. This trend toward virtual AD may aid outreach to vulnerable rural communities, improving health equity. More research is needed on the effectiveness of virtual AD and its future implications.
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Affiliation(s)
- Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tara R Hensle
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
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Cameron P, MacKinnon K, Mahalik A. Transitioning to virtual academic detailing amid COVID-19: A case study. J Am Pharm Assoc (2003) 2024; 64:483-491. [PMID: 38246271 DOI: 10.1016/j.japh.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) public health protocols required medical educators to rapidly move curricula online. This included academic detailing (AD), a form of one-to-one or small group educational outreach for primary care providers (PCPs). OBJECTIVES This study aimed to contribute to the sparse evidence base exploring virtual AD by exploring strengths, challenges, and best practices. METHODS This case study drew on 3 methods: (1) observations of AD visits (n = 5 sessions), (2) group (n = 6 detailers) and one-on-one interviews (n = 5 PCPs, n = 3 detailing staff), and (3) document analysis of curriculum and policy documents (n = 10 documents). RESULTS Our analysis identified several strengths of virtual detailing: (1) inherent benefits of virtual programming, (2) pre-existing strengths in program leadership, (3) global move toward telehealth amid COVID, (4) pre-existing detailing relationships, and (5) pre-existing roles and attributes of pharmacists. Several challenges were also identified: (1) virtual presence in group visits, (2) establishing consistency across modalities, and (3) technological issues. CONCLUSION Virtual detailing has posed unique challenges and opportunities for innovation. Our study supports a blended model moving forward-one that balances strengths and challenges of virtual and in-person delivery and considers logistics, efficiencies, environmental impacts, and unique participant needs.
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Schjøtt J, Steen IL, Espnes KA, Riedel B. Self-perceived learning outcomes of virtual and in-person academic detailing among general practitioners in Norway. Basic Clin Pharmacol Toxicol 2024; 134:284-289. [PMID: 37949670 DOI: 10.1111/bcpt.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
Self-perceived learning outcomes of virtual academic detailing (AD) are poorly studied. We compared self-perceived learning outcomes of virtual and in-person AD among general practitioners (GPs). GPs from the Western region of Norway received a questionnaire before and after AD concerning rational pharmacotherapy of migraine in the autumn 2022. Five statements addressing specific knowledge and two statements addressing general knowledge and skills in pharmacotherapy of migraine were rated in both questionnaires. A 7-point Likert scale ranging from 1: Strongly disagree to 7: Strongly agree was applied to all the statements. Histograms that showed the difference in the mean composite scores before and after AD were used to compare learning outcomes of virtual and in-person AD. Positive self-perceived learning outcomes were observed among 80%-88% of the GPs. No significant differences between virtual and in-person AD were observed.
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Affiliation(s)
- Jan Schjøtt
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
- Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Ingrid Lunde Steen
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Midt-Norge), Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway
| | - Ketil Arne Espnes
- Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway
| | - Bettina Riedel
- Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Luetsch K, Wong G, Rowett D. A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter. BMJ Qual Saf 2023; 33:43-54. [PMID: 37142414 PMCID: PMC10804006 DOI: 10.1136/bmjqs-2022-015498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many quality improvement initiatives in healthcare employ educational outreach visits, integrating academic detailing to bridge evidence-practice gaps and accelerate knowledge translation. Replicability of their outcomes in different contexts varies, and what makes some visiting programmes more successful than others is unclear. OBJECTIVE We conducted a realist synthesis to develop theories of what makes educational outreach visiting integrating academic detailing work, for whom, under which circumstances and why, focusing on the clinician-visitor interaction when influencing prescribing of medicines in ambulatory care settings. METHODS The realist review was performed in accordance with RAMESES standards. An initial programme theory was generated, academic databases and grey literature were screened for documents with detail on contexts, intervention and outcomes. Using realist logic of analysis, data from 43 documents were synthesised in the generation of a refined programme theory, supported by additional theoretical frameworks of learning and communication. RESULTS Twenty-seven interdependent context-mechanism-outcome configurations explain how clinicians engage with educational outreach visits integrating academic detailing through programme design, what matters in programme design and the educational visitor-clinician interaction and how influence extends beyond the visit. They suggest that in addition to relevance, credibility and trustworthiness of a visit's contents, communication and clinical skills of educational visitors, the relationship between the educational visitor and clinician, built on a dialogue of learning from and sense-making with each other, creates conditions of critical thinking which are conducive to facilitating prescribing practice change when necessary. CONCLUSION This realist synthesis elucidates that the quality of clinician-educational visitor interactions is pivotal to educational outreach visiting programmes. Building and sustaining relationships, and establishing an open dialogue are important; neglecting these undermines the impact of visits. Educational visitors can facilitate clinicians' reflection on practice and influence their prescribing. Clinicians value the discussion of individualised, tailored information and advice they can translate into their practice. PROSPERO REGISTRATION NUMBER CRD42021258199.
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Affiliation(s)
- Karen Luetsch
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debra Rowett
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Rawal S, Osae SP, Cobran EK, Albert A, Young HN. Pharmacists' naloxone services beyond community pharmacy settings: A systematic review. Res Social Adm Pharm 2023; 19:243-265. [PMID: 36156267 DOI: 10.1016/j.sapharm.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacists' provision of naloxone services in community pharmacy settings is well-recognized. Recently, studies describing pharmacists' naloxone services in settings other than community pharmacies have emerged in the literature. There is a need to synthesize evidence from these studies to evaluate the scope and impact of pharmacists' naloxone services beyond community pharmacy settings. OBJECTIVES The objectives of this systematic review were to a) identify pharmacists' naloxone services and their outcomes, and b) examine knowledge, attitudes, and barriers (KAB) related to naloxone service provision in non-community pharmacy settings. METHODS Eligible studies were identified using PubMed, Web of Science, and CINAHL. Inclusion criteria were as follows: peer-reviewed empirical research conducted in the U.S. from January 2010 through February 2022; published in English; and addressed a) pharmacists' naloxone services and/or b) KAB related to the implementation of naloxone services. PRISMA guidelines were used to report this study. RESULTS Seventy-six studies were identified. The majority were non-randomized and observational; only two used a randomized controlled (RCT) design. Most studies were conducted in veterans affairs (30%) and academic medical centers (21%). Sample sizes ranged from n = 10 to 217,469, and the majority reported sample sizes <100. Pharmacists' naloxone services involved clinical staff education, utilization of screening tools to identify at-risk patients, naloxone prescribing and overdose education and naloxone dispensing (OEND). Outcomes of implementing naloxone services included improved naloxone knowledge, positive attitudes, increased OEND, and overdose reversals. Pharmacists cited inadequate training, time constraints, reimbursement issues, and stigma as barriers that hindered naloxone service implementation. CONCLUSION This systematic review found robust evidence regarding pharmacist-based naloxone services beyond community pharmacy settings. Future programs should use targeted approaches to help pharmacists overcome barriers and enhance naloxone services. Additional research is needed to evaluate pharmacist naloxone services by using rigorous methodologies (e.g., larger sample sizes, RCT designs).
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Affiliation(s)
- Smita Rawal
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA.
| | - Sharmon P Osae
- Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA
| | - Ewan K Cobran
- Department of Quantitative Health Science, Mayo Clinic College of Medicine and Sciences, Scottsdale, AZ, USA
| | - Alexis Albert
- College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Henry N Young
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA
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Irwin AN, Bratberg JP, Al-Jammali Z, Arnold J, Gray M, Floyd AS, Bolivar D, Hansen R, Hartung DM, Green TC. Implementation of an academic detailing intervention to increase naloxone distribution and foster engagement in harm reduction from the community clinician. J Am Pharm Assoc (2003) 2023; 63:284-294.e1. [PMID: 36567216 PMCID: PMC9933140 DOI: 10.1016/j.japh.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Respond to Prevent (R2P) is a randomized clinical trial which sought to accelerate distribution of naloxone and other harm reduction materials from community pharmacies. R2P combined an online continuing education course with in-store materials, specifically designed for use in community pharmacies, and then supported implementation through the one-on-one educational technique of academic detailing. OBJECTIVE The objective of this paper is to describe and synthesize our experiences providing academic detailing as part of the R2P randomized trial. METHODS Closed-ended items from standardized post detailing questionnaires were analyzed with descriptive statistics. Open-ended items were content analyzed for key themes using immersion-crystallization qualitative methods. RESULTS A total of 176 pharmacies participated in R2P with 175 receiving their initial academic detailing visit between August 2019 and May 2021. Initial visits were in-person and lasted a median of 35 minutes (interquartile range, 20-45 minutes). The R2P naloxone guide was the most common topic covered (n = 162, 92.6%). Following a fidelity check to assess adequacy of the R2P program implementation, 80 pharmacies (45.7%) required secondary academic detailing. Secondary detailing was more targeted and most frequently focused on the sale of nonprescription syringes (n = 28; 35.2%) or disposal container distribution (n = 30; 37.5%). Analysis of the open-ended items identified factors that the detailers perceived to affect the quality of academic detailing sessions, including the pharmacy environment, participant knowledge of and attitudes toward the subject matter, and ability of the detailer to remain flexible yet consistent. CONCLUSION R2P provided a standardized process to foster naloxone distribution and engagement in harm reduction with demonstrated implementation in 175 community pharmacies across 4 states. Academic detailing was perceived to be well-received and effective at providing education and promoting distribution of naloxone and nonprescription syringes in community pharmacies. Additional research is needed to confirm these perceptions through evaluation post-intervention behavioral and attitude changes.
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Singh N, Dube SR, Varshney U, Bourgeois AG. A comprehensive mobile health intervention to prevent and manage the complexities of opioid use. Int J Med Inform 2022; 164:104792. [PMID: 35642997 DOI: 10.1016/j.ijmedinf.2022.104792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Opioid Use crisis continues to be an epidemic with multiple known influencing and interacting factors. With the need for suitable opioid use interventions, we present a conceptual design of an m-health intervention that addresses the various known interacting factors of opioid use and corresponding evidence-based practices. The visualization of the opioid use complexities is presented as the "Opioid Cube". METHODS Following Stage 0 to Stage IA of the NIH Stage Model, we used guidelines and extant health intervention literature on opioid apps to inform the Opioid Intervention (O-INT) design. We present our design using system architecture, algorithms, and user interfaces to integrate multiple functions including decision support. We evaluate the proposed O-INT using analytical modeling. RESULTS The conceptual design of O-INT supports the concept of collaborative care, by providing connections between the patient, healthcare professionals, and their family members. The evaluation of O-INT shows a preference for specific functions, such as overdose detection and potential for high system reliability with minimal side effects. The Opioid Cube provides a visualization of various opioid use states and their influencing and interacting factors. CONCLUSIONS O-INT is a promising design with a holistic approach to manage opioid use and prevent and treat misuse. With several needed functionalities, O-INT design serves as a decision support system for patients, healthcare professionals, researchers, and policy makers. Together, O-INT and the Opioid Cube may serve as a foundation for development and adoption of highly effective m-health interventions for opioid use.
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Affiliation(s)
- Neetu Singh
- Department of Management Information Systems, University of Illinois at Springfield, Springfield, IL 62703, USA.
| | - Shanta R Dube
- Department of Public Health, Levine College of Health Sciences, Wingate University, Wingate, NC 28174, USA.
| | - Upkar Varshney
- Department of Computer Information Systems, Georgia State University, Atlanta, GA 30302, USA.
| | - Anu G Bourgeois
- Department of Computer Science, Georgia State University, Atlanta, GA 30302, USA.
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