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

2. Set Up for Using Poll Everywhere
Text to this number: 22333
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4. 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.

5. 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

6. 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

7. Description of Academic Detailing Visit
Short one-on-one meeting between detailer and prescribers
Usually 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

8. 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)

9. Why AR IMPACT is Offering AD:
National average for rate of opioid prescribing is 79.3 opioid prescriptions per 100 persons
Arkansas’ current rate of opioid prescribing is /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

10. Opioid Overdose Deaths

11. Arkansans are at risk for Chronic Pain:

12. 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 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%.

13. 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

14. 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

15. 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

16. Evaluating AR IMPACT–AD Program
Short 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.