Despite the availability of a growing body of CER reviews, non-evidence-based prescribing is common. """"""""Academic detailing"""""""" was pioneered by our team 30 years ago as a method of educational outreach that provides prescribers with accurate, non-commercial, and relevant data on medications in a user-friendly, interactive format that has been shown to change practice. Given its well documented effectiveness, many organizations, including numerous Medicaid programs, seek to implement programs of their own but lack the expertise and support to do so. We propose to develop a national resource center to adapt AHRQ's CER products for AD, and to train clinician-educators in AD methods to disseminate this information in a wide variety of settings. The availability of training on the techniques and content of AD, guidance on the establishment of such programs, and provision of adapted AHRQ products to use in AD will allow organizations that serve diverse patient populations, including many of the vulnerable and underserved patients likely to benefit most, to transform evidence-based information into improved patient-care decisions. We will begin by establishing a network of organizations seeking to implement the findings of AHRQ's CER findings in their own settings. We have received letters of support and interest from 26 organizations, including over a dozen Medicaid programs. The center will work with partner organizations to perform needs assessment of their current drug use patterns and lay the groundwork for establishing AD programs. Next we will adapt AHRQ's CER findings for four clinical areas (oral diabetes medications, insulin, atypical anti-psychotic drugs in dementia, and analgesics for osteoarthritis) into a form appropriate for effective AD. We will provide training sessions on the principles of social marketing, techniques of AD, and the clinical content of the adapted CER findings;these sessions will be offered on multiple occasions during the project period. We will then work with each partner organization to evaluate its AD activities across multiple dimensions. We will gather qualitative data on the process of implementation, the quality of training, and the experiences of clinicians receiving the AD messages. For state Medicaid programs we already have access to aggregate data that we will use to perform quantitative evaluations of the impact of detailing on prescribing patterns, and we will obtain analogous data from non-Medicaid partner organizations to perform similar evaluations. We will also provide guidance to participating programs on performing patient-level assessments of the impact of their interventions. The project will create a community of programs using this approach to disseminate non-commercial, evidence-based information on medication benefits and risks. This will enable us to identify factors that predict successful AD programs as well as pitfalls to avoid. In Year 3 of the project period, we will organize a large-scale conference on AD to bring together the organizations that partner with us as well as additional organizations that seek to learn about establishing such outreach programs of their own.

Public Health Relevance

AHRQ-supported CER reviews and clinician guides identify best approaches to prescribing, but their impact on care could be far greater if they were more actively disseminated. Academic detailing, built on the techniques of social marketing, is a powerful and proven means of educational outreach to change prescribing practice. We propose creating a national resource center to adapt AHRQ's CER products for AD, as well as create a resource to train outreach educators in implementing this approach.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZHS1-HSR-C (02))
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Kelly, Carmen
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Brigham and Women's Hospital
United States
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