The Pennsylvania Academic Detailing Program

Pharmaceuticals Conference

Evidence Based Medicine and Counter Detailing

National State Attorney General ProgramAt Columbia Law School

New York, New YorkMay 11, 2007

Thomas M. Snedden, (tsnedden@state.pa.us)

Director,Pennsylvania PACE Program

(www.aging.state.pa.us)

The Pennsylvania Academic Detailing Program

Academic detailing is a supplement to PACE’s long-standing, comprehensive, concurrent and retrospective DUR processes.

Program expectations

The medication educator’s role

Our goals To provide evidence-based, non-

commercial information about medications to physicians

To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for their patients

Program strengths:Service, credibility, and integrity

Service Providing useful, practice-relevant information… in a very time-efficient way… that would be difficult to assemble oneself… delivered in a professional, supportive manner.

Credibility Evidence-based materials, developed by experts Non-commercial viewpoint

Integrity Only goal is to improve prescribing and patient

care No pharmaceutical company funding Salary is not based on sales performance

Goal 1: To provide physicians with current, evidence-based, non-commercial drug information

HOW? Offer the physician a flexible schedule for visits

Respond to questions knowledgeably, honestly, and with the weight of the evidence—or find someone who can!

Offer free CME credits to add value to the interaction

Present a professional appearance and pleasant demeanor

Practice the art of persistence

Goal 2: To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for patients

HOW? Identify the physician’s needs, priorities, and

concerns

Offer tools and resources to facilitate better choices (data summaries, patient education materials, etc.)

Refrain from excessive bashing of drug manufacturers

What makes a medication educator unique?Drug rep

Serves: drug company

Product: drug

Goal: maximize use of a particular drug for profit$

Medication educator Serves: doctor

Product: knowledge about drugs

Goal: Share knowledge with doctor that will result in optimized prescription choices

Pharmaceutical company relationships No affiliations with a

pharmaceutical company (paid or unpaid) Consulting Employment Speakers

bureau/seminars/conferences

Educational modules completed (whom to treat, which drugs to choose)

Cox-2’s / NSAIDs Gastric acid: PPIs, H 2 blockers

Nexium, Prilosec, etc. Anti-platelet drugs

Plavix, aspirin Cholesterol-lowering drugs

Lipitor, Crestor, Zocor, other statins

Drug Consultants Clinical background in nursing, pharmacy

10 individuals employed 6 nurses, 4 pharmacists

7.5 FTE total Located in areas with highest density of

PACE beneficiaries Multi-day training sessions in Boston

regular followup teleconferences for updates, feedback

Quarterly one-on-one visits, ongoing relationships with prescribers

The Harvard connection Systematic review of current medical

literature evidence-based synthesis Development of user-friendly materials Follow-up, consultant support Responses to MD questions Fiscal management Program evaluation Web presence – www. RxFacts.org

Detailer activity through mid-November

N

Completed educational encounters 974

Unique providers who have had educational encounters

450

Educational encounters by topic*

iDiS introduction 175

coxibs/NSAIDs 362

PPIs, acid-suppressing therapy 340

anti-platelet therapy 240

statins, lipid-lowering therapy 2

Survey item:Mean ± SD

1=Strongly disagree 2=Disagree 3=Neutral 4=Agree 5=Strongly Agree

The program provides me with useful information about commonly used medications

4.6 ± .5

The content represents unbiased and balanced information about drugs

4.6 ± .5

The program provides a perspective on prescribing that is different form what I get from other sources

4.4 ± .6

My Drug Information Consultant is a well-informed source of evidence-based information about drugs I prescribe

4.6 ± .5

I find the patient materials useful in my practice 4.3 ± .8

Being able to get Continuing Medical Education credits from Harvard is a valuable component of the service

4.0 ± 1.2

It makes sense for the Commonwealth of Pennsylvania to devote resources to this activity

4.5 ± .6

I would like to see this program continue 4.6 ± .6

The media have noticed Wall Street Journal

Page One, March 13 “The Daily Show”

May 4, www. TheDailyShow.com The New York Times

op-ed, September 16 Harvard Magazine, The Harvard Health Letter

November The Boston Globe

February 26, 2007 The Central Pennsylvania Business Journal

April 2007

Effect on drug utilization:preliminary analysis

The cox-2 / NSAID module

0

200

400

600

800

1000

-18

-17

-16

-15

-14

-13

-12

-11

-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7

Months before and after intervention month

Cox

ib s

pend

ing

per p

hysi

cian

Internal control cohort

Intervention cohort

IDIS intervention month

Next steps Additional analyses are ongoing Additional drug topics to be covered:

–Hypertension–Alzheimer’s disease –Diabetes

Broaden to other state programs?–state employees/retirees

Questions