Academic Detailing: Advancing Evidenced-Based Prescribing

Physicians, pharmacists, policy makers, health advocates, educators and insurers convened on November 17, 2008 in Concord, New Hampshire to hear national speakers present at an event titled “Academic Detailing: Advancing Evidence-Based Prescribing.”

Marcia Angell, MD and Jerry Avorn, MD, both from Harvard Medical School, gave the keynote addresses.  Dr Angell, former editor-in-chief of the New England Journal of Medicine presented data on the pharmaceutical industry from her book The Truth about the Drug Companies.  Though the industry portrays itself as being focused on research and development of new drugs, Dr. Angell presented data suggesting it has offered relatively few breakthroughs in recent years while its spending on marketing has greatly out-striped its investment in research and development.

Dr. Avorn, Director of the Independent Drug Information Service, presented the concept of academic detailing which he originated in the early eighties.  Academic detailing, also known as prescriber outreach and education, borrows from the pharmaceutical  industry’s technique of one-on-one encounters within a physician’s office but uses the conversation as a chance to discuss the best available, evidence-based research on the comparative safety, efficacy and costs of prescription drugs.  It is not sales-driven like pharmaceutical detailing, but rather, is a non-commercial, broadly educational endeavor.   It creates the chance for interactive learning and has demonstrated its ability to better align physicians’ prescribing practices with the scientific evidence in both randomized, controlled trials and in full scale operational programs such as the one that Dr. Avorn directs for the Commonwealth of Pennsylvania.  It has almost demonstrated an ability to control costs while improving quality.

Dr. Charles MacLean and pharmacist Amanda Kennedy, co-directors of Vermont’s academic detailing program, engaged the audience with their portrayal of a mock academic detailing encounter in which treatment approaches to insomnia were discussed.  Samples of materials used in academic detailing can be found at the Vermont program’s website, www.vtad.org, or at the Independent Drug Information Service website, www.rxfacts.org.

Finally, New Hampshire state representative Cindy Rosenwald discussed state legislation on prescriber education, including laws passed in Maine, New Hampshire, Vermont, New York, Massachusetts and the District of Columbia.  Sharon Treat, a Maine state representative, completed the legislative overview by describing a federal academic detailing bill which would create a two-pronged grant program to develop the educational materials needed for prescriber education and to conduct the outreach necessary to make sure it reaches physicians in an effective manner.

The session was convened by the New Hampshire Medical Society in conjunction with the Maine Medical Association and Prescription Policy Choices.