Academic Detailing Just One Way to Improve Quality and Lower Costs

As described in the following summary, Dr. Avorn and his group at the Harvard Medical School continue their work on academic detailing, this time for the Pharmaceutical Assistance Contract for the Elderly program in Pennsylvania. Having done academic detailing in the past, I found that it was difficult to get quality face time with a significant number of physicians. It worked great in a staff-model HMO setting, but not in other HMO, PPO or indemnity settings. Even drug companies, with their samples, find it difficult to get more than 2 minutes of a physician's valuable time.

I found that targeted, concise prescribing analyses mailed to top prescribing physicians can have a greater impact on improving quality and lowering cost. This approach not only costs less, but has a greater impact on drug costs. This approach typically lowers trend by >6%. I am not saying not to use academic detailing, just use it where appropriate.

We also need to find the best ways to communicate this information directly to patients. Patients will take even more responsibility for prescribing decisions as patient pay continues to increase, whether through higher co-payments, co-insurance, deductibles and even more "exotic" benefit designs.

Academic detailing program seeks to educate physicians: Project uses big pharma tactics to reach out to docs

From Employee Benefit News (November 1, 2006)

A small group of consultants from the Harvard Medical School are trying to change the way physicians in Pennsylvania prescribe pharmaceuticals in an effort to reduce costs and medical errors.

The group, the Independent Drug Information Service, is taking a page from big pharma marketing teams by attempting to supply physicians with grounded, evidence-based drug information that's easy to decipher. The goal is to get them to supply the best medicine available at the best price.

IDIS says it's not trying to rival the marketing spending of the pharmaceutical industry. It probably couldn't match it if it tried. According to a an article published in the Journal of the American Medical Association in January, the pharmaceutical industry spends about 90% of its $21 billion marketing budget on physicians each year. The program is, however, attempting to copy the marketing tactics used by the pharmaceutical industry by visiting physician offices in person with easy-to-read, glossy materials that lay out the simple facts about a medical condition and its treatments.

"It's based on the idea that those of us in medical school faculty may have a lot of the data about what works and what doesn't, but we tend to be very ineffective communicators to doctors in the community," says Jerry Avorn, professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston. "Whereas the drug companies are far more sophisticated than we are in getting their point across. They get out to the doctors office, they sit with them and interact with them, which we don't do when we're lecturing. They've got these very engaging colorful materials with clear action points. And I was struck many years ago with the difference in those modes of communications."

Academic detailing

IDIS is funded through a program called the Pharmaceutical Assistance Contract for the Elderly, which operates under Pennsylvania's Department of Aging. The group follows a concept conceived and developed by Avorn called "academic detailing," which is defined as a form of continuing education for physicians in which evidence-based information about best prescribing practices is delivered to them by specially trained drug information consultants through one-on-one or small group visits.

The three-year program was started in September 2005, and focuses on medication used by patients covered under PACE. It will eventually follow those covered by Medicaid, state employee and retiree insurance plans and other state-supported prescription programs.

"We have, for the better part of two decades, been very concerned about the prescribing of medications, particularly for the elderly," comments Tom Snedden, director of PACE. "This academic detailing program is just one more step in trying to deal with misprescribing."

Snedden says the program looks promising and has been well received by Pennsylvania's physician community.

"We're using a preeminent medical school and putting a lot of people in the field and knocking on a lot of doors. We haven't had a lot of success with medical education in the past. But I'm hopeful this time we'll make a difference"

IDIS estimates there are about 1,000 physicians eligible for academic detailing under the project's current guidelines. The group completed its third report in April, a review of antiplatelet drugs prescribed for myocardial infarction, stroke and other cardiovascular events. The report notes that the brand-name drug Clopidogrel (plavix (product, search)) "has been increasingly used ... since 1996 ... [but] costs substantially more than aspirin."

It concludes that, "choosing the right antiplatelet therapy requires an understanding of the benefits and risks of specific antiplatelet regimens."

The antiplatelet report and other materials developed under PACE are "completely non-commercial in nature and uninfluenced by any company marketing plan," notes Avorn.

"It simply looks at what's out there in medical literature and gives an unbiased and user-friendly summary of the literature." -C.S.

Employers welcome

IDIS says it has quickly gained the trust of the physicians it has visited, particularly when they discover the consultants aren't there on a sales call.

"We've worked very hard to make sure they recognize we're not there to push a product," remarks Michelle Spetman, IDIS project manager. "Once we've established the relationship, we've realized the physicians are super-excited to see us."

Spetman says IDIS employs about 10 drug consultants to visit with physicians, and that they're looking to hire a few more in the coming months.

While the academic detailing program has so far been limited to Pennsylvania, Avorn says he's beginning to receive inquiries from other interested parties, and that he would welcome working with employers.

"Now that we've been doing this for over a year, we would be open to working with employers and would be interested in working with some to do this," says Avorn. "It becomes very worthwhile for the employer to want to have this cost-effective and quality assurance message going out instead of just leaving the field to the drug sales reps and letting them have their way with the doctors."

Avorn says he views academic detailing as "both a public service and research area."

After having worked with nursing homes, Medicare and physician offices statewide in Pennsylvania, he believes the next logical step is to work with large employers to further measure the economic impact of this program.

Jerry Avorn of the Harvard Medical School says his group's materials are "completely non-commercial in nature and uninfluenced by any company marketing plan."

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