1. The Pennsylvania Academic Detailing Program Pharmaceuticals Conference Evidence Based Medicine and Counter Detailing National State Attorney General Program At Columbia Law School New York, New York May 11, 2007 Thomas M. Snedden, (tsnedden@state.pa.us) Director, Pennsylvania PACE Program (www.aging.state.pa.us)

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

3. Program expectations The medication educator ’ s role

4. 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

5. 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

6. 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

7. 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

8. 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

9. Pharmaceutical company relationships No affiliations with a pharmaceutical company (paid or unpaid) Consulting Employment Speakers bureau/seminars/conferences

10. 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

11. 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

12. 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

13. Detailer activity through mid-November N Completed educational encounters974 Unique providers who have had educational encounters 450 Educational encounters by topic* iDiS introduction175 coxibs/NSAIDs362 PPIs, acid-suppressing therapy340 anti-platelet therapy240 statins, lipid-lowering therapy2

14. 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 practice4.3 ±.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 continue4.6 ±.6

15. 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

16. Effect on drug utilization: preliminary analysis The cox-2 / NSAID module

18. 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

19. Questions