An 'Academic Detailing' Intervention To Decrease Exposure to HIV Infection among Health-care Workers

Feasibility and acceptability of virtual academic detailing on opioid prescribing

INTRODUCTION

Social distancing requirements during COVID-19 pose a challenge to conducting traditional academic detailing, which typically involves in-person peer education visits to improve patient outcomes. The main alternative is to conduct virtual academic detailing delivered through web-based technology, but this approach is fraught with many challenges. This study aimed to examine the feasibility and acceptability of a virtual academic detailing program implemented among health care providers.

METHODS

The academic detailing program focused on appropriate opioid prescribing and chronic non-cancer pain management among a sample of providers. An initial in-person visit was followed by a virtual visit up to 8 weeks later. Videoconferencing was used to conduct the virtual visit with telephone as a backup. Feasibility was assessed whether the virtual visits could happen, and acceptability was assessed by provider satisfaction. Validated measures of Provider Satisfaction with Academic Detailing (PSAD) and Detailer Assessment of Visit Effectiveness (DAVE) with a 5-point Likert-type scale were used. Higher scores corresponded to higher satisfaction and greater perceived effectiveness. Non-parametric and parametric statistical tests were used to compare instrument summary scores across visits and between groups. Pairwise analyses across visits only included instrument responses for providers who participated in both visits and completed both surveys in their entirety.

RESULTS

There were 127 (90 %) initial in-person visits completed out of 141 visits scheduled, with a survey response rate of 96 %. Out of 120 virtual follow-up visits scheduled, 92 (77 %) were conducted, and 56 surveys (61 %) were collected. There was a high level of satisfaction with the initial and follow up virtual academic detailing visits, though, among providers who participated in both visits and had completed surveys (n = 50), initial visits had slightly higher scores (mean difference = -2.94 [95 % Confidence intervals: -4.38, -1.50], p < 0.001). There was no significant difference in detailer perception across the two visits as seen in the scale summary score (0.05 [-0.56, 0.66], p = 0.86) and two individually reported items related to feasibility (0.07 [-0.29, 0.42], p = 0.72) and conversation (-0.05 [-0.28, 0.17], p = 0.63). Forty-one (44.6 %) virtual visits were conducted using WebEx, where video and screen sharing of visit content was possible, while the remaining 51 (55.4 %) were conducted using a telephone. There was no significant difference in provider satisfaction between WebEx vs. telephone visits (-1.47 [-4.99, 2.05], p = 0.82). Provider satisfaction was also not impacted by any technical difficulties as reported by the detailer (-0.04 [-3.30, 3.38], p = 0.98).

CONCLUSION

The results slightly favor in-person visits and suggest that virtual detailing visits need to incorporate strategies that minimize technical difficulties and prevent participants from defaulting to less favorable technology. Future research opportunities include evaluating the effectiveness of a virtual versus in-person delivery of AD program on outcomes such as providers' opioid prescribing behavior.

‘You Sort of Switch Off’: Exploring Mindlessness in Injecting Drug Users’ Accounts of Blood

Risk of blood borne virus among injecting drug users is high and is a significant challenge for public health efforts. Mindlessness/mindfulness theory provides an alternative lens through which to understand social phenomena. Interview transcripts of 32 current and former injectors were explored for evidence of mindless injecting (or automatic behaviour). Mindlessness in injecting practices can be important as opportunities to reduce injecting risk can emerge from understanding ‘expert’ approaches to injecting. Further work is required to generate fuller understandings of this construct on injecting drug use and to incorporate carefully and sensitively this tool into health promotion efforts.

Principles and uses of academic detailing to improve the management of psychiatric disorders

OBJECTIVE

The purpose of this article is to discuss the principles of academic detailing, or educational outreach, in primary care and review the evidence of its effectiveness in, and potential for improving, mental health care.

METHODS

The general educational research literature on improving physician performance was reviewed along with studies that were designed to test academic detailing. Four rigorous studies have tested this approach specifically on mental health care. These studies are reviewed in detail.

RESULTS

Measuring pre-intervention performance to target those with increased educational needs and identifying barriers to change are associated with substantially improved program effectiveness. To change strongly held beliefs or to overcome patient demands, person-to-person contact with credible experts who provide structured alternatives is necessary. Brief reinforcement visits increase success rates and targeting programs to physicians at greatest need improves the cost effectiveness of educational interventions.

CONCLUSIONS

Academic detailing is one of the few educational interventions that has consistently demonstrated improved physician performance. Educational outreach methods to improve mental health practices in primary care are in need of much additional research. Improving the detection of mental disorders and underuse of mental health treatment may prove to be more difficult than reducing the overuse of unnecessary medications.