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Pharmacist As an Academic Detailer: Benefits and Challenges

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병원약사회지(2016), 제 33 권 제 2 호 J. Kor. Soc. Health-syst. Pharm., Vol. 33, No. 2, 111 ~ 121 (2016) Original Article Pharmacist as an Academic Detailer: Benefits and Challenges Zhenji Jina, Madihab, Changqing Yangc� Pharmacist, Department of Pharmacy, The Affiliated Hospital of Yanbian University, Jilin, Chinaa Lecturer,Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad Campus, Pakistanb College of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Jiangsu, Chinac Abstract :“Academic detailing”(AD) is a form of interactive educational outreach to physicians or other health care staff for providing unbiased, noncommercial, evidence-based information about medications and other therapeutic decisions, with the goal of improving patient care and reducing health care costs. Many trials have been carried out to establish this technique as an effective tool for continuous education of medical staff which in response leads to safe prescribing patterns. In this review we have summarized the studies that evaluated the role of pharmacist as an academic detailer in different settings, targeting different group of medications and achieving different objectives. Some studies that compared academic detailing to other educational methods or technology oriented techniques are also included. Various factors that promote or discourage academic detailing by phar- macist have been discussed. Pharmacist led educational outreach is found to be effective in changing the prescribing behavior, but on the other hand some researchers have observed insignificant effects. Further research is required to determine the best possible structure ensuring fruitfulness of this technique. 투고일자 2016.2.17; 심사완료일자 2016.3.2; 게재확정일자 2016.4.1 �교신저자 Changqing Yang Tel:(86)-25-86185447 E-mail:[email protected] - 111 - JKSHP, VOL.33, NO.2 (2016) [Key words] Academic detailing, Pharmacist, Prescribing trends, Physicians Introduction health professional such as a physician or phar- macist visiting physicians in their offices to pro- “Academic detailing”(AD) is a form of interac- vide evidence based information.4) tive educational outreach to physicians or other Like pharmaceutical detailing, AD also hopes health care staff to provide unbiased, noncom- to influence physicians’prescribing patterns mercial, evidence-based information about without any commercial interest. Its aim is to medications and other therapeutic decisions, visit a doctor and disseminate evidence-based with the goal of improving patient care and information about specific drugs or classes of reducing health care costs.1) This practice was drugs, after conducting impartial and independ- established in 1983 by Dr Avorn J and Dr ent reviews of their efficacy. The long-term goal Soumerai of Harvard Medical School-USA, as a is simply to promote optimal prescribing.5) method for continuous medical education The actual concept is derived from“detailing” , designed to change physicians’pharmaceutical a technique used by pharmaceutical companies prescribing habits.2) Many researchers have to market their products, where a sales repre- identified it as a useful method for improving sentative visit individual prescribers and per- drug prescribing trends.3) It involves a trained suade them to prescribe the company’s product. - 112 - Zhenji Jin : Pharmacist as an Academic Detailer: Benefits and Challenges But AD is not just limited to provision of drug countries like USA, UK, and Canada.1) Some intervention related knowledge, it deals with developing countries have also carried out some wider information. The goal of AD is that pre- trials on AD like Sudan, Argentina and Uruguay, scribing trends for targeted drugs are consistent India, Zambian, Cuba, Mexico, Indonesia and with medical evidence from randomized con- Pakistan.9) Japan has also recently recognized trolled trials, which ultimately improves patient this useful method in improving drug related care and reduces health care costs. A major fact knowledge of prescribers.1) The detailers in these is that academic detailers/clinical educators, the studies were either medical personnel or aca- program managers or developers etc. do not demics from different institutions, and have have any financial links to the pharmaceutical shown positive impact on different aspects of industry and are employed by non-profit organ- prescribing of various drugs. In our review we izations. According to Soumerai SB and Avorn J, have only focused the studies where pharmacists AD includes Interviewing, Defined Programs, played the role of academic detailer, targeted for Setting Objectives, Credible and Impartial various health care professionals including doc- Information, Motivating Active Interaction, tors, nurses, and other staff and provided them Multimedia Education, Repeated Elaboration, information regarding different groups of drugs. and Positive Reinforcement.2),6) Recently in 2013, technology-enabled AD has also been intro- Method duced, which is computer-mediated education between pharmacists and physicians for evi- 1. Data sources dence-based prescribing.7) Many developed countries have various uni- MEDLINE and Google scholar were searched versity-based state programs or those led by for articles published from January 1980 till non-profit organizations, which provide physi- December 2014. Using“Academic detailing by cians with updated and regular information pharmacist”and related phrases, we performed regarding various aspects of drugs. For example regular searches of the indexed literature. Alosa Foundation runs an AD program in Articles only written in English were considered. Pennsylvania and Washington, DC called the Independent Drug Information Service (IDIS). 2. Data selection Programs also exist in Canada managed by dif- ferent organizations such as Canadian Academic From the resulting database we selected stud- Detailing Collaboration (CADC), BC (British ies that met the following criteria: randomized Columbia) provincial AD service, RxFiles, controlled trials or interventional studies based Prescription management services of Manitoba, on academic detailing; studies that included Center for effective practice (Ontario). In physicians or prescribers; detailing was carried Australia, the Drug and Therapeutics out by pharmacist or pharmaceutical drug advi- Information Service (DATIS) and the National sor (getting no financial benefits) and objective Prescribing Service (NPS) also provide the assessments of either physician prescribing detailing programs.8) trends or its health care outcomes. We have also AD has been studied and evaluated in various included articles where personal detailing is - 113 - JKSHP, VOL.33, NO.2 (2016) compared with technology based interventions centers/clinics or hospitals, whereas four in or sole drug vouchers distribution. Articles nursing homes. Other settings were Academic where academic detailing is carried out by doc- Medical Center/Out Patient Clinic, Prepaid tors, nurses or other health care providers other group practice setting and independent practice than pharmacists are excluded. setting. Considering the method being utilized for AD, in fifteen studies pharmacist has indi- Results vidual meeting with the prescribers, seven stud- ies have used group detailing method while AD is a very wide term. A lot of work has three trials have tested group detailing versus already been done on this topic. Physicians, individual method. In three studies computer nurses, academicians, pharmacists and different alerts/technology based interventions were nonprofit organizations have worked or have compared with the pharmacists’AD, and in one been working on AD for last 30 years. More study it was compared with sole distribution of than seventy articles were retrieved, including generic drug vouchers to the target group. reviews, reports and trials. But the purpose of Table 1 shows the trials being selected, type of this review is to elaborate the role of pharmacist the pharmacist as detailer, method of detailing, as an academic detailer. So we have included 26 targeted group of professionals being detailed different trials where pharmacists have carried and targeted medications. out this reach out task and had shown an impact on prescribing trends. In seven studies Discussion detailer was a clinical pharmacist, two have used community pharmacists, in one study it 1. Role of Pharmacist in AD was a clinical research and drug information pharmacist, and in another one it was a phar- Pharmacist himself can play the role of aca- maceutical advisor where as in remaining other demic detailer as; the evidence reviewer for top- trials mostly pharmacists working in the partic- ics, developer of key messages and content/sup- ular settings were trained prior AD. porting tools, developer of the evaluation The groups of drugs mostly targeted were framework or he can be a trainer of other aca- antibiotics (five studies), lipid lowering drugs demic detailers.34) Pharmacists with or without (four studies), cardiac diseases related drugs doctoral-level training have been effective in (five studies), antidepressants (five studies), AD.10) They are often considered to play a role in anti-rheumatoid, anti-diabetic medicines (one AD because of their training in pharmacology study), anti-asthmatic drugs (one study) and and drug information. But some studies have proton pump inhibitors (one study). As we have shown that physicians may be reluctant to considered the articles that must at least target receive education from
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