Portland Press Herald
By Jennifer Reck, Policy Analyst

August 06, 2009

HALLOWELL — As we watch and wait for health care reform at the federal level this year, Maine is taking an important step forward for its citizens.

This month, Maine will launch a service aimed at providing unbiased, evidence-based information to prescribers regarding certain treatment options and the medications they prescribe.

The Maine Independent Clinical Information Service is a voluntary service made available to doctors and other prescribers. The program is administered by the Maine Medical Association in partnership with the Department of Health and Human Services.

It is also guided by a physician-led advisory committee. The program is intended to help doctors help their patients by keeping them up to date on the most current, unbiased scientific information on the treatment of common clinical problems, such as diabetes, the initial focus of this service.

Trained clinicians, known as "academic detailers," visit practice sites for individual or group discussions based on independent literature reviews conducted by the Independent Drug Information Service of Harvard Medical School.

These physician researchers at iDiS conduct extensive, scientific reviews that time-pressured physicians simply don't have time to do for themselves anymore.

But the academic detailer does more than just deliver this information to a physician's practice site.

He or she also initiates meaningful, interactive discussions of key findings rather than simply adding more paper to a towering "to read" list. As well, he or she asks doctors about the clinical challenges they face and tries to speak directly to the individual's needs and experiences.

This type of educational dialogue is how adult professionals actively learn.

DATA PROGRAM'S ONLY 'PRODUCT'

The pharmaceutical industry has long known that individual visits to a physician's office can be effective. That is why it has cultivated a sales force that just recently peaked around 100,000.

The industry's sales representatives get paid on commission for promoting the use of their brand-name drugs – regardless of whether there are safer and more time-tested, affordable and clinically effective options. It is not part of their job to objectively compare choices. Their job is to get their brand prescribed as much as possible.

In contrast to the industry approach, academic detailers are not trying to sell anything. Their only "product" is independent, scientific information. Since the prescribing decision is always left to the professional judgment of the individual prescriber, academic detailing simply adds to a doctor's available tools to help their patients as they see fit.

Maine is a part of the national momentum around academic detailing, represented by existing programs in Pennsylvania, Vermont, South Carolina, New York, Massachusetts and the District of Columbia.

At the federal level, there is a bill that would create a federal grant program available to entities such as states that wish to take on academic detailing. The considerable funds that the Obama administration is investing in research on comparative clinical effectiveness research should also help yield a wealth of new information that academic detailing can help deliver to physicians.

COLLABORATION HELPS CUT COSTS

The Maine Independent Clinical Information Service came about as the result of a 2007 legislative mandate intended to improve health care quality and outcomes. Maine has actively participated in collaborative efforts with other states undertaking academic detailing, with the intent of maximizing the program's impact while minimizing its administrative costs.

This commitment led to the contract with the Independent Drug Information Service for the educational materials used in Maine, rather than conducting these costly reviews on a state-by-state basis. Other states have followed suit, and iDiS is emerging as a national center for credible, independent academic detailing materials and training.

Physicians have responded very favorably to existing academic detailing programs because the programs facilitate their ability to do what they want to do – make the best, evidence-based choices about the clinical recommendations and prescribing decisions they make on behalf of their patients.

Ultimately, this approach can play a role in delivering better health care to consumers at lower costs, an outcome we'd all like to see from ongoing reform efforts.

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