Jennifer L. Reck,

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Creating Effective Prescriber Education and
Outreach Programs

• Jennifer L. Reck,
• Policy Analyst,
• Prescription Policy Choices

Righting the Script The Prescription Project
Washington, DC, December 9, 2008
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Prescription Policy Choices

• Nonprofit, nonpartisan 501(c)(3) educational and
  public policy organization focused on
  prescription drug policy
• Evaluate policies and programs that effectively
  reduce prescription drug prices, increase access
  to medications, minimize conflicts of interest
  promote evidence-based prescribing

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Academic Detailing - Definition

• Also known as prescriber education and outreach
• Practice of sending highly-trained clinicians to
  prescribers practices in order to discuss
  objective, comparative, evidence-based
  information on benefits, risks and
  cost-effectiveness of commonly used drugs

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Academic Detailing Legislationin Northern New
England

• ME passed legislation funding academic detailing
  in 2007
• VT expanded funding for its program in 2007
• NH passed legislation supporting academic
  detailing in May of 2008

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An opportunity to collaborate
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Northern New England Academic Detailing Planning
Initiative

• PPC convened stakeholders in ME, NH and VT for an
  academic detailing planning initiative in the
  spring of 2008
• Informational summit to identify best practices
  from existing programs
• Working groups to identify potential points for
  collaboration between programs to maximize impact
  with limited resources
• White Paper useful resource for any state

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Academic Detailing Planning Initiative Funders

• Nathan Cummings Foundation
• Consumers Union
• Endowment for Health
• Maine Health Access Foundation
• The Bingham Program
• Community Catalyst / The Prescription Project

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Existing Prescriber Education Programs

• US
• Pennsylvania (since 2005, administered by
  Harvards Independent Drug Information Service,
  www.RxFacts.org)
• Vermont (since 1999)
• South Carolina (since 2007, Medicaid / mental
  health focused)
• Worldwide Australia, Canada

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Emerging Prescriber Education Programs

• Maine
• New Hampshire
• New York
• Massachusetts
• Washington, DC

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Methodology

• Service-based approach
• Interactive approach creates a vehicle for
  understanding the needs of the prescriber as a
  bottom-up guide for a program (mutual learning)
• Common clinical challenges that prescribers face
  are often also concerns for payers
• win/win (improving quality, lowering costs)

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An Interactive Method
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Delivery

• Voluntary, not mandatory
• Incentives (useful information, CME)
• Avoiding targeting high prescribers, policing
  prescribing behavior not a basis for establishing
  the rapport necessary for good communication
• Focus on physicians that have many patients from
  a targeted program rather than a specific
  prescribing profile

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Components of academic detailing

• Identifying clinical topics for focus
• heartburn, type 2 diabetes, hypertension,
  depression, insomnia, elevated cholesterol, pain
• Conducting literature reviews
• Developing key messages and physician and patient
  educational materials
• iDiS materials available at www.rxfacts.org
• Updating materials

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Components of academic detailing

• Recruiting academic detailers
• Training academic detailers
• content
• communication skills
• Managing field personnel
• Team meetings for knowledge exchange/support
• Software tailored to academic detailing

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Advisory boards

• Potential participants
• Depts. of Public Health / Health Human
  Services Medicaid programs, pharmacy boards,
  pharmacy assistance programs, state employee
  organizations, state hospitals, corrections
• Pharmacy schools, medical schools, Area Health
  Education Centers, CME programs
• Medical societies / associations, consumer
  groups, existing evidence-based /
  quality-improvement initiatives

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Conflict of interest policies

• Must remain free of COI to meet the goals of
  academic detailing and maintain credibility
  (evidence-driven)
• Programs should formalize COI policies

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But theres no money to do it.
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Funding Models

• Manufacturer/labeler fees (ME, VT)
• Pharmaceutical sales representative licensing
  fees (WDC) or registration fees
• Pharmaceutical industry settlements (Neurontin/
  PA) (Zyprexa?)
• Medicaid (SC) / Medicaid matching funds
• General funds (MA and NY) / lottery (PA)
• Federal grants?

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Resources

• Model Act to Create an Evidence-Based Prescriber
  Education Service
• A Fact Sheet on Academic Detailing
• both at www.prescriptionproject.org
• A Template for Establishing and Administering
  Prescriber Support and Education Programs A
  Collaborative, Service-based Approach for
  Achieving Maximum Impact
• at www. policychoices.org

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Contact jreck_at_policychoices.org