Academic Detailing (AD): A New Resource From AR-IMPACT Teresa Hudson, PharmD, PhD Associate Professor, Department of Psychiatry CE Credits: TEXT: 501-406-0076  Activity Code:30083-24581

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Goals of AR IMPACT-AD Program Decrease high-risk prescribing of opioids Daily dose >50 MME Prescribing for longer than 3-7 days Prescribing to patients with history of SUD Increase use of other pain management strategies NSAID/Acetaminophen Other medications for neuropathic pain Physical therapy Exercise: walking, stretching, etc.

Presentation Objectives: After attending this presentations, participants will be able to: Define academic detailing and understand how this strategy is relevant to prescribing opioid medications Discuss evidence for effectiveness of academic detailing Understand the implementation of academic detailing as a resource from AR-IMPACT

What is Academic Detailing (AD)? An innovative, 1-on-1 outreach education technique that helps clinicians provide evidence-based care to their patients. Gerry Avorn, MD Patterned after detailing visits used by pharmaceutical industry Focus is on evidence for a particular treatment AD visits may also focus on lack of evidence for a particular treatment During visit, implementation of evidence-based treatments to replace non- evidence based treatment are discussed

Description of Academic Detailing Visit Short one-on-one meeting between detailer and prescribers Usually 10-20 minutes Focus on 1-3 messages around a particular topic. For example, how to wean opioids and use of non-opioid analgesics Can be tailored to the patient population of that prescriber Often Delivered by a pharmacist Many programs use a range of healthcare professionals along with health educators Usually involves some written materials that may be retained by the prescriber

Effectiveness of Academic Detailing Widely used by VA to: Decrease high dose antipsychotic Decrease antipsychotic polypharmacy Decrease high risk opioid prescribing Increase CPT for PTSD Other studies have shown AD to be effective in: Increasing pneumococcal vaccination – (Caffrey et al 2017) Increased use of NSAIDs for pain – (Bruyndoncks et al 2018) Decreasing use of cerebral and peripheral vasodilators, oral cephalosporin antibiotics, and propoxyphene (Avorn and Soumerai 1983)

Why AR IMPACT is Offering AD: https://www.cdc.gov/drugoverdose/maps/rxstate2017.html National average for rate of opioid prescribing is 79.3 opioid prescriptions per 100 persons Arkansas’ current rate of opioid prescribing is 102-111/100 persons 66/75 Arkansas counties have rate higher than national average 86% of heroin users report previous use of prescription opioids Sources: family, friends, personal prescriptions

Opioid Overdose Deaths

Arkansans are at risk for Chronic Pain:

Prevalence¶ of Self-Reported Obesity Among U. S Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2017 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

AR IMPACT-AD Program Funded through grant from CDC to Arkansas Dept. of Health Subcontract to UAMS – AR IMPACT team Timeframe: expected to end September 30, 2019 Team: AR IMPACT team – review all AD materials AR IMPACT Pain Specialist available for one-on-one consultation Emergency Department Physician available for one-on-one consultation Primary Academic Detailer: Armenda Young, PharmD Project Manager: Amanda Lunsford, MA

AR IMPACT-AD Program Features: Materials/messages focused common opioid prescribing problems: Tapering strategies for opioids Non-opioid analgesic medications for pain Non pharmacotherapy options for pain Communicating with patients about pain PDMP data used to identify prescribers who prescribe: High MME daily dose High number of pills for chronic use Have large number of patients receiving opioids

AR IMPACT-AD Program Features: Make appointment with prescriber at their convenience Visit in person to talk about challenges in pain management Discuss materials/messages relevant to that prescriber Prescribers will have the opportunity to give feedback on visit Suggest other topics Request visits if needed

Evaluating AR IMPACT–AD Program Short email survey to prescribers who receive AD visit Evaluation of change in prescribing practices Tracking outcome of visits Tracking requests for additional visits on specific topics Roll-out in “step-wise” fashion to compare prescribing rates at places who did and did not receive AD.

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