VA Academic Detailing Service: Implementation and Lessons Learned
Educational outreach topics covered thus far by the VA AD program include clozapine utilization, metabolic monitoring and use of antipsychotics, PTSD, treatment-resistant depression, alcohol use disorder, and chronic pain management. Each topic focused on specific key messages or key points that are emphasized during the detailing visit with the provider (Table).
Lessons Learned
This pilot program identified several changes that should be considered for future implementation. First, leadership must endorse and support educational sessions with clinicians. Introduction of educational programming begins with creating a collaborative relationship with health care system leadership. Each medical center in the pilot program had an infrastructure of Mental Health, Primary Care, and Pharmacy Service leaders who supported the AD program. In addition, AD Service participation on committees, such as Mental Health Executive Committee, Mental Health Task Force, VISN PBM, and Medication Safety, allows the AD program’s members to network with clinicians and align its key messages with the goals of the facility and leadership. Aligning with existing programs enhances and promotes resources for clinicians and supports leadership and performance goals.
To collaborate, HCPs needs to understand how the AD program benefits them. Before clinicians are approached regarding participation, the AD program should be developed into a branded collaborative program that offers numerous benefits to them, their practice, and their patients. The program must provide a clear and credible answer to the question, “Why should I spend my time meeting with you?”
Second, reaching HCPs for face-to-face encounters over large geographic areas requires an organized network of academic detailers with adequate administrative support. Partnerships with staff already present in the clinic are essential for consistent reinforcement and delivery of the key messages. These partnerships allow station-level staff to continually identify opportunities to act on the key messages. By using local champions, the AD Service can effectively cover a large territory. Providing education to remote facilities can be done by telephone or video teleconferencing.
Third, many HCPs recognize the value this program can add to their practice and have requested follow-up sessions with the academic detailers. To better understand the needs, baseline knowledge, readiness, and receptivity of target audiences, the AD Service should deploy an informal needs assessment to HCPs. The feedback can be used to prepare the appropriate strategies and messaging during AD sessions.
Fourth, the VA chose to use CPSs with experience working as provider extenders for medication management as the primary academic detailers for this pilot. It should be noted that AD services in other national and international systems are successfully performed by other types of HCPs with this same level of qualifications and expertise. Regardless of profession, the academic detailer must have the qualifications and expertise necessary to empower clinical personnel. Without this expertise, provider buy-in is difficult to obtain. As a result, behavior change will be less likely. Pharmacists currently serve as the drug information experts for patients and health care teams. They are valued across professions for their knowledge of medication management, and they have the capacity to recommend nonpharmacologic evidence-based treatments. In addition, using drug information experts as academic detailers allows them to serve as a resource for more complex patient cases.
Finally, providing real-time audit and feedback tools with educational resources gives clinicians tangible actions to improve the care they deliver and proactively target interventions anticipated in the upcoming appointments. It is helpful for HCPs to see the culture of their prescribing compared with prescribers across the network because this can identify areas for improvement and highlight strong practices. Use of audit and feedback tools with a team approach allows for delegation of duties where team members may contribute and collaborate to reach patient goals and improve patient care. Using information technology to deliver this product to health care teams is an important component of the AD program. For successful implementation, resources are needed from both clinicians and the Office of Information and Technology to develop and maintain these powerful tools.
Conclusion
The VA AD Service uses a multifaceted approach to promote the use of evidence-based treatment in veterans with mental illness. Academic detailers, along with key thought leaders, identified opportunities to improve care with solutions for applying evidenced-based medicine. Several items are considered necessary for successful AD program implementation, based on the pilot program. These included endorsement and support by leadership; needs assessment prior to key message development to fully understand the needs, baseline knowledge, readiness, and receptivity of target audiences; highly qualified academic detailers with the training, expertise, and communication skills necessary to empower clinical personnel; and real-time audit and feedback tools with education to give clinicians tangible actions to improve care.
The VA AD Service, including provision of educational services, clinical consultation, health systems barrier resolution, and audit and feedback tools, presents a new opportunity for pharmacists to improve the quality of care of veterans. The impact of the VA AD program on evidence-based care prescribing is being analyzed and will be reported in the future.
