Pharmacist As an Academic Detailer: Benefits and Challenges

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 pharmacist 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 pharmacist 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 different 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 studies 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 a person who is not a the physicians or prescribers, four studies have physician.29),35) Some concerned that non-physi- also included nurses for AD, and three of them cians could not answer their questions at the have also provided detailing to other staff mem- time of the visit and others were uncertain if it bers along with the prescribers. Most studies would be a wise use of their time. But in the have been conducted in primary health care same study some physicians have shown

- 114 - Zhenji Jin : Pharmacist as an Academic Detailer: Benefits and Challenges

Table 1. Trials involving pharmacists as academic detailers

Authors/ Year Pharmacist Healthcare Method used Target group/ Countries/ as Academic setting for AD Target medications Ref. No. detailer Avorn J. 1983 Clinical Primary care Individual meeting Physicians/Cerebral and (USA)2) pharmacist peripheral vasodilators, an oral cephalosporin, and propoxyphene

Soumerai SB. 1986 Clinical Primary care Face to Face Physicians/ (USA)10) Pharmacist Random

Avron J. 1992 Clinical Nursing home Face to Face Physicians, Nurses, Aides/ (USA)11) pharmacist Psychoactive agents

Hartlaub PP. 1996 Clinical Prepaid group Face to Face vs. Physicians/Benzodiazepines (USA)12) pharmacist practice setting Group detailing

Diwan VK. 1995 Pharmacist Primary Care Group detailing Physicians/ (Sweden)13) Lipid lowering drugs

Baran RW. 1996 Trained Independent Individual meeting Physicians/ (USA)14) pharmacist practice association Lipid lowering drugs

Peterson GM. 1996 Pharmacist Primary Care Individual meeting Physician/Rheumatic drugs (Australia)15)

Wahlstorom R. 1997 Community Community Group detailing Physicians/Hyperlipidemics (Sweden)16) pharmacist health care

Ilett KF. 2000 Clinical Pilot study Individual meeting General practitioners/ (Australia)17) Pharmacist Antibiotics

Turner CJ. 2000 Community Community care Individual meeting Physicians/ (USA)18) pharmacist CHF related drugs

Elizabeth E. 2001 Pharmacist Nursing Home Group detailing Staff/Hypnotics (Norway)19)

Siegel D. 2003 Trained Academic medical Individual meeting Physicians/ (USA)20) Pharmacist Center/Out Patient Anti-hypertensives Clinic

Crotty M. 2004 Pharmacist Residential care Individual meeting Physicians/ (Australia)21) setting Falls and stroke

Seager JM. 2006 Trained Dental health Individual meeting General dental (Wales)22) pharmacist centers practitioners/Antibiotics

Awad AI. 2006 Pharmacist Primary care Individual vs. General prescribers/ (Sudan)23) group detailing Antibiotics

MagriniN. 2007 Pharmacist Primary care Individual vs. GP/Random (Italy)24) Group detailing

Bailey TC. 2007 Clinical Hospital settings Individual meeting Physicians/ (USA)25) pharmacist vs. Computer alerts Coronary heart disease

- 115 - JKSHP, VOL.33, NO.2 (2016)

Authors/ Year Pharmacist Healthcare Method used Target group/ Countries/ as Academic setting for AD Target medications Ref. No. detailer Eccles MP. 2007 Pharmaceutical Primary care Individual meeting General practitioners/ (UK)26) advisor Antidepressant

ZwarensteinM. 2007 Trained Store front Individual meeting General practitioners/ (South Africa)27) Pharmacist practices Asthma

Bhargava V. 2010 Hospital Physician Hospital Group detailing vs. Physician/Random (Canada)28) Pharmacist Organization Generic Drug Voucher

Chui D. 2011 Clinical Community hospital Individual vs. Physician/ (Canada)29) research Group detailing proton pump inhibitor pharmacist

Linnebur SA. 2011 Pharmacist Nursing Home Group detailing Nurses and Physicians/ (USA)30) Antibiotics

Lowrie R. 2012 Pharmacist Primary care Group detailing Physician, Nurses, Staff/ (USA)31) Statins

Hartung DM. 2012 Clinical Rural family Face to face vs. Physicians/CNS drugs (USA)32) pharmacist practice clinics Video conferencing

Avery AJ. 2012 Pharmacist Primary care Group vs. Physician, nurses, staff/ (UK)33) Technology based Medication related error intervention

Ho K. 2013 Trained Primary care Academic detailing General practitioners/ (Canada)7) pharmacist vs. Technology Diabetes medication use based AD

AD: Academic detailing; encouraging response to information provided scribers, a study has shown that a generic med- by pharmacists.35) ication voucher program in addition to academic A study has shown that a trained pharmaceu- detailing in an outpatient setting was associated tical advisor is ineffective detailer, although the with a small but statistically significant increase reason is not the un-satisfaction by physicians, in adjusted overall Generic dispensing ratio it is assumed to be the untargeted educational (GDR).28) Although print materials alone may be outreach.26) There are studies that have com- marginally cost-effective, print along with pared the pharmacists’educational out-reach face-to-face approach offer greater benefits. with the technology based interventions or The authors conclude that a program of brief, alerts to the prescribers and the results show face-to-face“detailing”visits conducted by that pharmacists’led AD along with the com- academics rather than commercial sources can puter generated feedback is more effective than be a highly cost-effective method for improving relying on technology solely.25),33) AD can enhance drug therapy decisions.10) the effectiveness of voucher or simple leaflet To establish AD as a clinical pharmacist's role, oriented drug knowledge provided to the pre- it is necessary to strengthen drug information

- 116 - Zhenji Jin : Pharmacist as an Academic Detailer: Benefits and Challenges

skills of pharmacists, such as guideline or liter- clinics and nursing homes. In residential care ature search skills and journal evaluation. settings, studies have showed much variation in Simultaneously, it is important to introduce new results, like from positive impact11) to no pharmaceutical education curriculums regarding effects.21) Although later study was assumed to evidence-based medicine (EBM), pharmacoeco- be effected by the trial design, but it is also nomics, and professional communication in stated by some researchers that AD may have order to explore pharmacists' roles in the future. different effects in different settings.12) Studies showed that detailing by clinical phar- Individual, face to face detailing is generally macist was successful in modifying prescribing considered to be more effective than group patterns and also improved cost effectiveness detailing. The results of the studies involving for drugs.10),18) In one study, first computer alerts individual meeting are more promising than were given to clinical pharmacists about the those of group activity. In Sudan, a multifaceted patients with high levels of Troponin I, pharma- intervention was carried out to improve pre- cists then conducted AD for physicians caring scribing practices in health centers of Khartoum for these patients. It has been effective in state. Twenty health centers were randomly changing physician prescribing behavior.25) assigned to receive: (1) no intervention; (2) audit Avron J concluded such educational programs and feedback; (3) audit, feedback and seminar or by clinical pharmacists can enhance attempts to (4) audit, feedback and AD. Results showed that counter the overuse of psychoactive drugs in the multifaceted interventions involving audit and aged residents of nursing homes, although this feedback combined with AD appeared to be study has limitation of short duration.11) Still in more effective in changing prescribing practices one study, Chui D has showed that AD by clini- of antibiotics than audit and feedback alone or cal research pharmacist was not effective in with seminars.23) Individual meeting can be more improving physicians prescribing trends of pro- cost effective than the group interventions or ton pump inhibitors. Reasons were assumed to seminar as it saves the money used for organiz- be either physician’s reluctance to pharmacists ing these events, although it may take more detailing or short duration of detailing session time of the detailer to go and have individual (10 min).29) Similar is the case for community encounter with every prescriber. Comparing in- pharmacists, where although some trials person approaches to distance interactions showed positive results,16) but their role as aca- (video conferencing), participants of a study demic detailer is still questionable, as a study preferred the first one.32) But a recent study involving the use of prescription records and AD showed Technology aided academic detailing by community pharmacist did not affect pre- (TEAD) is an acceptable alternative to AD for scribing pattern for ACE inhibitors but demon- providing physicians advice about prescribing. strated value as a quality assurance tool.26) AD is TEAD is more time efficient, facilitates effective mostly carried out in primary health care set- knowledge exchange and inter-professional col- tings targeting the physicians or general pre- laboration, and can reach those physicians vir- scribers. But it has also been tested in settings tually where face-to-face AD is not possible or like store front practices, independent practice practical.6) A role for pharmacists in the moni- associations, prepaid group settings, outpatient toring of individual residents’prescriptions, in

- 117 - JKSHP, VOL.33, NO.2 (2016)

AD or in guideline development could help in Lack of faith in pharmacist, no objectivity, lim- improving the quality of prescribing for nursing ited time and resources were some limiting fac- home residents.36) tors. A well structured and planned AD with visible demonstration projects and large multi- 2. Challenges center research is required to ensure maximum benefits. Several studies have found that physicians highly rate the educational value of AD. And it References has proven to enhance their professional com- petence.2),10),11) To be most effective, physician 1) Yamamoto M.: Academic detailing for best education must be conducted by a person who is practice and pharmacist’s role. Yakugaku- viewed as a colleague or opinion leader.37) AD is Zasshi, 134(3), 355-362 (2014) likely to be successful if the program is well 2) Avorn J., Soumerai S.B.: Improving drug- thought out and discussed before implementa- therapy decisions through educational out- tion especially if combined with other educa- reach. A randomized controlled trial of aca- tional and managerial interventions. Relevance demically based“detailing” . N Engl J Med, of the topic and quality of written material pro- 308 (24), 1457-1463 (1983) vided were the promoting factor. Most studies 3) O’Brien M.A., Rogers S., Jamtvedt G., showed that AD by pharmacist was effective in Oxman A.D., Odgaard-Jensen J., Kristoffersen changing prescribers’behavior. But some stud- D.T., Forsetlund L., Bainbridge D., Freemantle ies have shown that it was just effective as N., Davis D.A., Haynes R.B., Harvey E.L.: quality assurance tool or limiting the excessive Educational outreach visits: effects on pro- cost. Problems of finding time or short duration fessional practice and health care outcomes. of detailing session, lack of faith of physician in Cochrane Database Syst Rev, 4:CD000409 pharmacists’knowledge, lack of incentives for (2007) the detailer and objectivity of the information 4) Hafeez A., Mirza Z.: Responses from phar- provided could be possible hindering factors. maceutical companies to doctors’requests Spending office time doing Continuing Medical for more drug information in Pakistan: Education (CME) was a factor which deterred postal survey. BMJ, 319(7209), 547 (1999) most physicians.34),35),38) 5) Kondro W.: Academic drug detailing: an evidence-based alternative. CMAJ, 176(4), 429- Conclusion 431 (2007) 6) Soumerai S.B., Avorn J.: Principles of edu- AD by pharmacist especially clinical pharma- cational outreach ‘academic ( detailing’) to cist has shown somewhat effectiveness in improve clinical decision making. JAMA, changing physicians’pharmaceutical prescrib- 263(4), 549-556 (1990) ing habits. Results of technology based pharma- 7) Ho K., Nguyen A., Jarvis-Selinger S., Novak cist AD programs or those substituted with Lauscher H., Cressman C., Zibrik L.: leaflets or vouchers based education and involv- Technology-enabled academic detailing: ing feedback system were much encouraging. computer-mediated education between

- 118 - Zhenji Jin : Pharmacist as an Academic Detailer: Benefits and Challenges

pharmacists and physicians for evidence- 16) Wahlstrom R., Dahlgren L.O., Tomson G., based prescribing. Int J Med Inform, 82(9), Diwan VK., Beermann B.: Changing 762-771 (2013) Primary Care Doctors’Conceptions - A 8) Wikipedia, the free encyclopedia: http://en. Qualitative Approach to Evaluating an wikipedia.org/wiki/Academic_detailing, Intervention. Advances in Health Sciences Accessed December 28, 2014 Education, 2(3), 221-236 (1997) 9) Shankar P.R., Jha N., Piryani R.M., 17) Ilett K.F., Johnson S., Greenhill G., Mullen Bajracharya O., Shrestha R., Thapa H.S.: L., Brockis J., Golledge C.L., Reid D.B.: Academic detailing. Kathmandu Univ Med J Modification of general practitioner pre- (KUMJ), 8(29), 126-134 (2010) scribing of antibiotics by use of a therapeu- 10) Soumerai S.B., Avorn J.: Economic and tics adviser (academic detailer). Br J Clin policy analysis of university-based drug Pharmacol, 49(2), 168-173 (2000) “detailing”. Med Care, 24(4), 313-331 (1986) 18) Turner C.J., Parfrey P., Ryan K., Miller R., 11) Avorn J., Soumerai S.B., Everitt D.E., Brown A.: Community pharmacist outreach Ross-Degnan D., Beers M.H., Sherman D., program directed at physicians treating Salem-Schatz S.R., Fields D.N.: A random- congestive heart failure. Am J Health Syst ized trial of a program to reduce the use of Pharm, 57(8), 747-752 (2000) psychoactive drugs in nursing homes. New 19) Eide E., Schj�tt J.: Assessing the effects of Engl J Med, 327(3), 168-173 (1992) an intervention by a pharmacist on pre- 12) Hartlaub P.P., Barrett P.H., Marine W.M., scribing and administration of hypnotics in Murphy J.R.: Evaluation of an intervention nursing homes. Pharmacy World and to change benzodiazepine-prescribing Science, 23(6), 227-231 (2001) behavior in a prepaid group practice set- 20) Siegel D., Lopez J., Meier J., Goldstein ting. Am J Prev Med, 9(6), 346-352 (1993) M.K., Lee J., Brazill B.J., Matalka M.S.: 13) Diwan V.K., Wahlstrom R., Tomson G., Academic detailing to improve antihyper- Beermann B., Sterky G., Eriksson B.: tensive prescribing patterns. American Effects of“group detailing”on the prescrib- Journal of Hypertension. 16(6), 508-511 ing of lipid-lowering drugs: a randomized (2003) controlled trial in Swedish primary care. J 21) Crotty M., Whitehead C., Rowett D., Hal- Clin Epidemiol, 48(5), 705-711 (1995) bert J., Weller D., Finucane P., Esterman 14) Baran R.W., DuChane J., Parker L., A.: An outreach intervention to implement Cornwell S., Franic D., ErwinW.G.: evidence based practice in residential care: Effectiveness of academic detailing in the a randomized controlled trial [ISRCTN managed care environment: improving pre- 67855475]. BMC Health Serv Res, 4(1), 6 scribing of lipid-lowering agents. J (2004) Managed Care Pharm, 2, 148-157 (1996) 22) Seager J.M., Howell-Jones R.S., Dunstan 15) Peterson G.M., Bergin J.K., Nelson B.J., F.D., Lewis M.A., Richmond S., Thomas Stanton L.A.: Improving drug use in rheu- D.W.: A randomised controlled trial of clin- matic disorders. J Clin Pharm Ther, 21(4), ical outreach education to rationalise 215-220 (1996) antibiotic prescribing for acute dental pain

- 119 - JKSHP, VOL.33, NO.2 (2016)

in the primary care setting. Br Dent J, physician-hospital organization. Journal of 201(4), 217-222 (2006) Managed Care Pharmacy. 16(6), 384-392 23) Awad A.I., Eltayeb I.B., Baraka O.Z.: (2010) Changing antibiotics prescribing practices 29) Chui D., Young F., Tejani A.M., Dillon E.C. in health centers of Khartoum State, : Impact of academic detailing on proton Sudan. Eur J ClinPharmacol, 62(2), 135-142 pump inhibitor prescribing behaviour in a (2006) community hospital. Canadian Pharmacists 24) Magrini N., Formoso G., Marata A.M., Journal. 144(2), 66-71 (2011) Capelli O., Maestri E., Voci C., Nonino F., 30) Linnebur S.A., Fish D.N., Ruscin J.M., Brunetti M., Paltrinieri B., Maltoni S., Radcliff T.A., Oman K.S., Fink R., Dorsten Magnano L., Bonacini M.I., Daya L., Viani B.V., Liebrecht D., Fish R., McNulty M., N.: Randomised controlled trials for evalu- Hutt E.: Impact of a multidisciplinary ating the prescribing impact of information intervention on antibiotic use for nursing meetings led by pharmacists and of new home-acquired pneumonia. American information formats, in General Practice in Journal of Geriatric Pharmacotherapy. 9(6), Italy. BMC Health Serv Res, 7, 158 (2007) 442-450 (2011) 25) Bailey T.C., Noirot L.A., Blickensderfer A., 31) Lowrie R.: A cluster randomised controlled Rachmiel E., Schaiff R., Kessels A., trial of pharmacist-led Statin Outreach Braverman A., Goldberg A., Waterman B., Support in primary care. PhD Thesis, Dunagan W.C.: An intervention to improve University of Glasgow. 257 (2012) secondary prevention of coronary heart 32) Hartung D.M., Hamer A., Middleton L., disease. Arch Intern Med, 167(6), 586-590 Haxby D., Fagnan L.J.: A pilot study eval- (2007) uating alternative approaches of academic 26) Eccles M.P, Steen I.N., Whitty P.M., Hall L. detailing in rural family practice clinics. : Is untargeted educational outreach visit- BMC Fam Pract, 13, 129 (2012) ing delivered by pharmaceutical advisers 33) Avery A.J., Rodgers S., Cantrill J.A., effective in primary care A pragmatic ran- Armstrong S., Cresswell K., Eden M., domized controlled trial. Implementation Elliott R.A., Howard R., Kendrick D., Science. 2, 23 (2007) Morris C.J., Prescott R.J., Swanwick G., 27) Zwarenstein M., Bheekie A., Lombard C., Franklin M., Putman K., Boyd M., Sheikh Swingler G., Ehrlich R., Eccles M.P., A.: A pharmacist-led information technol- Sladden M., Pather S., Grimshaw J., ogy intervention for medication errors Oxman A.D.: Educational outreach to gen- (PINCER): a multicentre, cluster ran- eral practitioners reduces children’s asthma domised, controlled trial and cost-effec- symptoms: a cluster randomised controlled tiveness analysis. Lancet, 379(9823), 1310- trial. Implement Sci, 2, 30 (2007) 1319 (2012) 28) Bhargava V., Greg M.E., Shields M.C.: 34) Jin M., Naumann T., Regier L., Bugden S., Addition of generic medication vouchers to Allen M., Salach L., Chelak K., Blythe N., a pharmacist academic detailing program: Gagnon A., Dolovich L.: A brief overview of effects on the generic dispensing ratio in a academic detailing in Canada: another role

- 120 - Zhenji Jin : Pharmacist as an Academic Detailer: Benefits and Challenges

for pharmacists. Canadian Pharmacists Journal, 145(3), 142-146 (2012) 35) Allen M., Ferrier S., O’Connor N., Fleming I.: Family physicians’perceptions of academic detailing: a quantitative and qualitative study. BMC Med Educ, 7, 36 (2007) 36) Lunn J., Chan K., Donoghue J., Riley B., Walley T.: A study of the appropriateness of prescribing in nursing homes. Inter- national Journal of Pharmacy Practice. 5(1), 6-10 (1997) 37) Carter B.L., Helling D.K.: Ambulatory care pharmacy services: has the agenda changed? Ann Pharmacother, 34(6), 772- 787 (2000) 38) Davis D.A., Thomson M.A., Oxman A., Haynes R.B.: Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA, 268(9), 1111-1117 (1992)

- 121 -