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Monday, November 6, 2017 | Day 1 Breakouts: “AD in Action”

Breakout1:AD101:DeconstructinganADVisit|Room216

Breakout2:RecognizingRisksinaOne‐sidedMessage:TheImportanceandChallengeofBalanceinKeyMessaging|Room217

Breakout3:YourADTerritoryisHOWBig?Trials,Tribulations,andBreakthroughsinRuralAD|Rotunda/MainSessionRoom

Tuesday, November 7, 2017 | Day 2 Breakouts: “Advanced Lessons in AD”

Breakout1:CreatingEngagingEducationalMaterials:VisuallySupportingYourKeyMessages|Rotunda/MainSessionRoom

Breakout2:GainingClinicianAccess:SuccessesandChallengesinADPrimaryCarePhysicianRecruitment|Room217

Breakout3:DevelopinganADProgram:WorkingThroughtheLensofCulturalCompetence|Room216

 

 

DAY 1: MONDAY, NOVEMBER 6TH, 2017 DetailedAgenda&SessionDescriptions

AllmainsessionswillbeheldintheRotunda,withtheexceptionofafternoonbreakoutsasnoted.PresentationslideswillbeavailableatonourConferenceHubpageatnarcad.orgaftertheconference.

8:30AM Breakfast&Networking

9:00AM OPENINGREMARKS&WELCOME|MichaelFischer,MD,MS,NaRCADDirector

9:30AM KEYNOTETALK:“GettingOutofOurComfortZone:DetailingonPrEPandPEPinNewYorkCity”ZoeEdelstein,PhD,MS|DirectorofResearchandEvaluation,HIVPreventionProgramNYCDepartmentofHealthandMentalHygiene,BureauofHIV/AIDSPrevention&Control

10:15AM MorningBreak

10:30AM EXPERTPANEL:PrEP‐aringProvidersfromCoasttoCoast:ADforHIVPreventionModerator:DouglasKrakower,MDPanelists:AlysonDecker,NP,MS,MPH;JingLuo,MD,MPH;DeborahMonaghan,MDClinical outreach education on Pre‐exposure Prophylaxis (PrEP) for HIV prevention presents theunique opportunity to provide outreach on a biomedical intervention that has clearly identifiedindications, a strong scientific evidence base, a relatively slowuptakeby clinicians, andpotentialstigmachallengesforprovidersandpatients.Thispanelwillexaminesuccessesacrossthecountry,withanemphasisonreducinghealthdisparitiesthroughprioritizedoutreach,strategiesforprovideroutreach,evaluationmethods,andcapacitybuilding.

12:00PM

Lunch

12:45PM

BREAKOUTSESSIONS:“ADinAction”

AD101:DeconstructingtheADVisit(Room216,2ndFloor)AmandaKennedy,PharmD,BCPS,&BevinK.ShagouryWhatreallyhappensduringa1:1visitwithaclinician?Howdoacademicdetailerspreparetomakeeveryvisitcount?JointhishighlyinteractivesessionfacilitatedbymembersoftheNaRCADtrainingteam as they break down the key elements of a successful educational visit through small groupexercisesandproblem‐solving.Thissessionwillbeespeciallybeneficialforattendeespreparingtoworkasclinicaleducators,orforthoseseekingnewinsightsandskillsrefinement. Ideal forthoseplanningtocompleteafutureNaRCADADtechniquestraining.

RecognizingRisksinaOne‐SidedMessage:TheImportanceofChallenge&BalanceinMessaging(Room217,2ndFloor)LorenRegier,BA,BSP&BrendaSchuster,BSP,ACPR,PharmD,FCSHPCarefuldeliberationinthecraftinganddeliveryofkeymessagesiscriticaltodetailercredibility.Theartofcreatingakeymessage to ignitebehaviorchangecarriesrisks ifyourkeymessage is (or isperceivedtobe)one‐sided.Considerationsforbalanceinmessagingwillservetomitigatesuchrisks,butmayappeartothreatenthedesiredbehaviorchange.Participantswillhavetheopportunitytoevaluateandassesspotentialkeymessages,usingvariousclinicaltopicareasfordiscussion,includingantipsychoticsinlong‐termcare,opioidsinchronicnon‐cancerpain,andantibiotics.

YourADTerritoryisHOWBig?Trials,Tribulations,andBreakthroughsinRuralAD(Rotunda/MainSessionSpace,3rdFloor)AronNenninger,BScPharm,RPh&CristiFroyman,BScPharm,RPhManyAcademicDetailingprogramsaredesignedwithurbancentersanddensepopulationsastheirprimaryaudience.Joinusforthisinteractivebreakoutsessionwherewewillexplorethesuccesses,trialsandtribulationsoftheBritishColumbiaPADAcademicDetailerswholiveandworkinsparselypopulated, sometimes remote rural communities. A little forethought can result in busy, efficientdetailers expanding the possibilities of AD to rural and remote health care providers, who oftenembraceitwithopenarms.

2:15PM AfternoonBreak

2:30PM DAY1FIELDPRESENTATIONS:SharingbestpracticesviaarapidroundofhighlightsfromrecentADfieldinterventions.

2:30–2:35 Kick‐off&Overview:MikeFischer,MD,MS2:35–2:45 Presentation1:“UsingADinAHRQ’sEvidenceNOW:AdvancingHeart

HealthinPrimaryCareinOklahoma” StevenCrawford,MD,HealthyHeartsforOklahoma2:45–2:50 AudienceQ+A2:50–3:00 Presentation2:“ThinkingOutsidetheBox:AcademicDetailingand

PracticeFacilitationforGroupsN>1"DanelleCallan,MA&RobertRhyne,MD,UniversityofNewMexico

3:00–3:05 AudienceQ+A3:05–3:15 Presentation3:“ClinicalADasPartofCommunityCoalitionsand

PublicHealthActivitiestoSupportChronicDiseaseSelf‐managementandPrevention:ExperiencesinNewYorkState” 

RobertMorrow,MD,AlbertEinsteinCollegeofMedicine 3:15–3:20 AudienceQ+A3:20–3:30 Presentation4:“ReducingAnti‐PsychoticsforDementiaPatientsin

NursingHomes:CombiningADwithOtherImplementationStrategiestoEnhanceUptake”MeganMcCullough,PhD,CenterforHealthcareOrganizationandImplementationResearch(CHOIR),VA

3:30–3:35 AudienceQ+A3:35‐3:45FinalAudienceQ+A&Wrap‐up

3:45PM AnnualADTalk:“NavigatingaDisorientingHealthcareLandscape”JerryAvorn,MD,Co‐DirectorofNaRCAD

4:30PM Day1ClosingRemarksMichaelFischer,MD,MS,DirectorofNaRCADPleasetakeamomenttofilloutourDay1Evaluationform.

5:00PM‐6:00PM

EveningNetworkingReceptionJoinusjustoutsidetheRotundaforhorsd'oeuvresanddrinks!

DAY 2: TUESDAY, NOVEMBER 7TH, 2017 DetailedAgenda&SessionDescriptions

DAY2FIELDPRESENTATIONSSharingbestpracticesviaarapidroundofhighlightsfromrecentADfieldinterventions.

12:45–12:50 Kick‐off&Overview:MikeFischer,MD,MS

12:50–1:00 Presentation1:“EvaluationofADonPrescribingPatternsforAttention‐Deficit/HyperactivityDisorder”JackiTraversPharmD,PharmacyManagementConsultants

1:00–1:05 AudienceQ+A

1:05–1:15 Presentation2:“Patient‐specificADforSmokingCessation”MargaretJin,BScPharm,PharmD,MSc,HamiltonFamilyHealthTeam 

1:15–1:20 AudienceQ+A

1:20–1:30 Presentation3:“AD toOptimizeMedicationPrescribingforPatientswithHeartFailurewithReducedEjectionFractionAcrossaVANetworkofMedicalCenters” AddisonRagan,PharmD,BPCS,VeteransAffairsSoutheasternNetwork

 

1:30–1:35 AudienceQ+A

1:35–1:45 Presentation4:“ProviderEngagementReducesConcurrentUtilizationofAntipsychotics”CrystalHenderson,PharmD,BCPP&KristinBrown‐Gentry,MS,MagellanHealth

1:45–1:50 AudienceQ+A

1:50–2:00 Presentation5:“ImprovingSafeOpioidPrescribingintheEmergencyDepartment”SameerAwsare,MD,KaiserPermanente

2:00–2:05 AudienceQ+A

2:05–2:20 Presentation6:“Assisting Providers in the Reduction of Benzodiazepine Utilization in Veterans with PTSD using an AD Framework” MarkBounthavong,PharmD,MPH&SarahPopish,PharmD,BCPPVeteransHealthAdministration PBMAcademicDetailingService

 

2:20–2:30 FinalAudienceQ+A&Wrap‐up

8:30AM Breakfast&Networking9:00AM ReflectionsonLearning|MichaelFischer,MD,MS,DirectorofNaRCAD

9:15AM KEYNOTETALK:“HowPhysiciansLearnandChange:TheRoleofAD”CarolHavens,MDDirectorofPhysicianEducationandDevelopment,KaiserPermanenteMedicalCareProgram,NorthernCaliforniaRegion,ChemicalDependency&RecoveryProgram

10:00AM MorningBreak

10:15AM EXPERTPANEL:“AcademicDetailingfortheOpioidOverdoseEpidemic”Moderator:AletaChristensen,MPHPanelists:DonTeater,MD,MPH,NadejdaRazi‐Robertson,LCSW,PhD,SkyeTikkanen,MS,CSAC,LPC,ICS‐ITWith the help of the CDC,many states are implementing academic detailing programs toeducate prescribers on many aspects of the opioid epidemic. This panel will describeacademicdetailingefforts in two statesworkingwith theCDCwhile alsohighlighting theimpactofstigmaonacademicdetailingprograms.

12:00PM Lunch

      

2:30PM AfternoonBreak:Coffee&NetworkingEnjoyanextendedcoffeebreaktoconnectwithspeakersfromtheFieldPresentationsession,prepareforyourafternoonbreakoutsession.

3:00PM

4:30PM

BREAKOUTSESSIONS:“AdvancedLessonsinAD”

CreatingEngagingEducationalMaterials:VisuallySupportingYourKeyMessages(Rotunda/MainSessionSpace,3rdFloor)EllenDancel,PharmD,MPH&AmyBraddockDoyouhavecompellingcontent,butarestrugglingwithcreatingengagingmaterialstouseduringadetailingvisit?Joinusforaninteractivesessionwhereweconvertkeymessagesintographics that can amplify the impact of your program. This session will coverthebasicconceptsofgraphicdesign,andapplythoseconceptstoclinicalcontentscenarios.Otherareasoffocuswillincludeprintingandcostoptionsthatwillsupportclinicaloutreacheducationinterventionsingettingthemostvaluefromtheirprogrambudgets.

GainingClinicianAccess:Success&ChallengesinADPrimaryCarePhysicianRecruitment(Room217,2ndFloor)PatriciaChan,BScPharm,PharmD&TanyaMarshall,BScPharm,PharmDAcademic detailers and program managers need to develop strategies in recruiting andretainingprimarycarephysiciansforeducationaloutreachsessions.Thissessionwillfocuson various strategies to address challenging scenarios in recruitment and retention ofprimary carephysicians forADsessions.This sessionwill beof interest tobothnewandseasoned academic detailers as well as program managers working in urban and ruralsettings.

DevelopinganADProgram:WorkingThroughtheLensofCulturalCompetence(Room216,3rdFloor)DonTeater,MD,MPH&SkyeTikkanen,MS,CSAC,LPC,ICS‐IT Stigma is an important influence on medical professionals dealing with individuals withlifestylesdifferentfromtheirown,andstigmamayhaveanegativeeffectonbehaviorchangein the target group of any academic detailing effort. Stigma may also affect programdevelopers, managers, and practitioners, making it important to identify throughoutdevelopment and implementation of anyADprogram.Byutilizing a format of interactivediscussionandself‐reflection,thissessionwilllookattheissueofstigmaasiteffectstargetpopulations,andwillalsoexaminehowaddressingstigmamayinfluencetheoutcomeofADprograms.

StayingConnectedwithNaRCAD:ClosingRemarks&FinalAudienceQ+AMikeFischer,MD,MS,Director,NaRCADBevinK.Shagoury,CommunicationsDirector,NaRCAD

5:00PM

TowrapupDay2,membersofNaRCAD’shometeamwillsharetheofficiallaunchofanewproject,sharevirtualresources,answerquestions,anddiscussthemomentuminthefieldasweheadinto2018.ConferenceAdjournmentPleasecompleteyourDay2Evaluationform.

          

 Welcome to #NaRCAD2017, our 5th conference in this series. Our teamlooksforwardtomeetingallofyouoverthecourseofthesetwodays!

Wehopethisyear’sconferenceinspiresyouall to think about how you can adapt theprinciples and techniques of AD to youruniqueprograms.Thekeynotespeakerswillteach us how two very different types ofhealth organizations—amajorurbanhealthdepartmentandalarge,integratednon‐profithealthcaresystem—useADtoimprovecarefortheirpatients.Whetheryou’rehopingtostart a new AD program or to expand an

existingone,weknowthatlearningfromtheseleaderswillprovidetangiblesolutionstohelpmoveyouforward.

Butthemostexcitingpartoftheconference,forus,isseeingthegrowthofthiscommunity.Thenumberofsubmissionsfortheconferenceincreaseddramaticallyfrom2016,andwe’redelightedtofeaturepresentationsfromthefieldonbothdaysoftheconferencethisyear,inadditiontotheterrificcontentinthepanelsandbreakoutsessions.

Weencourageyoutotakethesetwodaystoexplorethekeyquestionsandchallengesthatyoufaceinyourwork.Asallofusinhealthcareareuncertainaboutthefuture,onecertaintyisthatclinicianscontinuetostruggletoidentifyandinterpretthebestmedicalevidenceandincorporateitintopractice.That’swhywehopethisconferencecreatesopportunitiesforeveryonetoconnectwithcolleaguesandourteam—whetheritbetobrainstormabouthowtomakebetteruseofdatatosupportADinitiatives,developnewfundingmodelsasthehealthcaresystemcontinuestochange,ortrainacademicdetailersforthemosteffectivemessagedelivery.

Let#NaRCAD2017inspireyoutotakethenextstepwithyourplansforAD,andplantoshareyourinnovationswithallofusatnextyear’sconference.Wehopeyou’llshareyourinsightsbyjoiningusonsocialmedia,andasalways,welookforwardtoyourcontributionsandfeedback. 

Michael Fischer, MD, MS, NaRCAD Director Jerry Avorn, MD, NaRCAD Co-Director 

Day 1 Keynote Biography Zoe Edelstein, PhD, MS

DirectorofResearchandEvaluationforHIVPreventionNewYorkCityDepartmentofHealthandMentalHygiene[DOHMH]

BureauofHIV/AIDSPreventionandControl

Dr. Zoe Edelstein is the Director of Research and Evaluation for HIVPrevention with the New York City Department of Health and MentalHygiene’s Bureau of HIV/AIDS Prevention and Control. In this role, sheoverseestheagency’sdata‐driven,evidence‐basedresearchandevaluationefforts related to HIV prevention, including evaluating HIV preventionactivitiesandcontracts,monitoringcitywidetrendsinHIVprevention,andconductingspecialprojects.TheseprojectsincludedevelopingPrEPmetricsusingmultipledatasourcesand overseeing the agency’s PrEP/PEP public health detailing campaign,whichhasvisitedover2,500primarycareandinfectiousdiseaseprovidersatover1,300clinicalsitesacrossNewYorkCity.Dr.EdelsteinreceivedherMSandPhDinEpidemiologyfromtheUniversityofWashington.

Day 2 Keynote Biography Carol Havens, MD

DirectorofPhysicianEducationandDevelopmentKaiserPermanenteMedicalCareProgram,NorthernCaliforniaRegion

ChemicalDependency&RecoveryProgram,KaiserPermanente

CarolHavens,MD, isDirectorofPhysicianEducationandDevelopmentattheKaiserPermanenteMedicalCareProgram,NorthernCaliforniaRegion,andisastaffphysicianofChemicalDependencyandRecoveryProgramatKaiserPermanente.SheisboardcertifiedinFamilyMedicineandAddictionMedicine. Dr. Havens received her undergraduate degree in MedicalTechnologyfromMichiganStateUniversityandhermedicaldegreefromtheUniversity of Arizona. She completed her residency training at theUniversityofCalifornia,Davis‐SacramentoMedicalCenterFamilyPracticeResidencyProgram.

Over the course of her career, Dr. Havens has held various leadershippositionsincludingPresidentoftheCAAFPin2011.Sheistheclinicallead

fortheTPMGOpioidInitiativeandiscurrentlyChairoftheCAFPCPDcommittee.SheservedaschairoftheCaliforniaMedicalAssociationCMEcommitteeandwasamemberandvice‐chairoftheboardofdirectors for the ACCME. She was named a Best Doctor in Sacramento 2005‐2016 and was theCaliforniaFamilyPhysicianoftheYearin2017fromCAFP.

Dr.Havenshasbeenpublishedinmorethan15peer‐reviewedjournalsandotherpublications,andistherecipientofCAFPFoundation’s2009BarbaraHarrisAwardforEducationalExcellenceandwasrecentlyannouncedCAFP’s2017FamilyPhysicianoftheYear.Dr.Havenslovestoteachbecauseshefinds it simultaneously renewing and helps her find balance in all that she does. Hermost recentavocationislearningtoplaytheukulele.

NaRCAD Staff

 JerryAvorn,MD|Co‐DirectorDr. Avorn is Professor of Medicine at Harvard Medical School and Chief of theDivision of Pharmacoepidemiology and Pharmacoeconomics [DoPE]. A generalinternistanddrugepidemiologist,hepioneeredtheconceptofacademicdetailingand isrecognized internationallyasa leadingexpertonthis topicandonoptimalmedicationuse.Thedivisionheleadsincludesfacultywithbackgroundsininternalmedicineand its subspecialties, geriatrics, epidemiology,health services researchandpolicy,biostatistics,andcomputerscience.Hismajorareasofresearchinclude:the scientific, policy, and social factors that shape physicians’ drug choices; theidentification and prevention of adverse drug effects; medication compliance bypatients;programstoimprovetheappropriatenessofprescribinganddrugtaking;and pharmaceutical cost‐effectiveness analysis. Dr. Avorn completed hisundergraduate training at Columbia University in 1969, received the M.D. fromHarvardMedicalSchoolin1974,andcompletedaresidencyininternalmedicineattheBethIsraelHospitalinBoston.HehasservedaspresidentoftheInternationalSocietyforPharmaco‐EpidemiologyandwasamemberoftheInstituteofMedicineCommitteeonStandards forDevelopingTrustworthyClinicalPracticeGuidelines.Dr.Avornistheauthororco‐authorofover500papersinthemedicalliteratureonmedicationuseand itsoutcomes, and isoneof themosthighly‐cited researchersworkingintheareaofmedicineandthesocialsciences.MichaelFischer,MD,MS|DirectorDr. Fischer is a general internist, pharmacoepidemiologist, and health servicesresearcher.HeisanAssociateProfessorofMedicineatHarvardandaclinicallyactiveprimary care physician and educator at Brigham & Women’s Hospital. He hasextensive experience in designing and evaluating interventions to improvemedicationuse andhaspublishednumerous studiesdemonstrating thepotentialgains fromimprovedprescribing.Hisresearch interests includeprescriptiondrugreimbursement policy, electronic prescribing, and medication adherence. Dr.FischerearnedhismedicaldegreefromtheYaleSchoolofMedicineandaMasterofSciencedegreeinhealthpolicyandmanagementfromtheHarvardSchoolofPublicHealth. He completed residency training in primary care internal medicine atBrigham & Women’s Hospital. He teaches in both the outpatient and inpatientcomponentsoftheinternalmedicineresidencyprogramatBrigham&Women’sandteachescoursesonresearchmethodologyatHarvardSchoolofPublicHealth.

NiteeshChoudhry,MD,PhD|ProgramFacultyDr.ChoudhryisaProfessorofMedicineatHarvardMedicalSchoolandanAssociatePhysicianintheDivisionofPharmacoepidemiologyandPharmacoeconomicsandtheHospitalistProgramatBrighamandWomen’sHospital.Hisresearchfocusesonthedevelopmentandevaluationofnovelstrategiestoimprovehealthcarequalityand reduce spending. He is particularly interested in the clinical and economicconsequencesof usingevidence‐based therapies for themanagementof commonchronic conditionsand indesigning strategies to overcomebarriers to treatmentinitiationandlong‐termmedicationadherence.Heleadsamultidisciplinaryresearchprogram funded by CVS Caremark to study medication adherence, the cost‐effectivenessofmedical technologies and comparativeeffectiveness researchandcollaborates with a wide range of insurers, employers and health deliverysystems.He is also the founding Executive Director of the Center for HealthcareDelivery Sciences. Dr. Choudhry practices inpatient general internal/hospitalmedicineatBrighamandWomen’sHospital.

BevinKathleenShagoury|Communications&EducationDirectorBevin manages NaRCAD’s external communications and strategic partnerships,overseeingNaRCAD'sPartnerNetworkandfocusingonforgingnewcollaborationsbetween clinical education programs. Having developedcommunications andeducational resourcesinclinical settings,urbanclassrooms,andhealthcare‐basednon‐profits, Bevinworks to highlight national best practices in the field, supportskillssharingacrossplatforms,andamplifytheimpactofclinicaloutreacheducation.Withcareerexperienceinnon‐profitprogrammanagement,increasingcommunityaccess tointegrated learning platforms, and developing interdisciplinaryeducational and training curricula,Bevin holds a degree in expressive educationfromEmersonCollege,withanemphasisonservingmarginalizedpopulations.Shehaspreviouslyheldprogrammanagementpositionswithorganizationsdedicatedtohomelessnessadvocacy,virtualeducationtosupportgrantornetworks,andclinicalcareforat‐riskyouthexperiencingacutetrauma. ArielleMather,MPH|Education&TrainingManagerAriellemanagesallofNaRCAD’sevents,includingtheAcademicDetailingTrainingTechniques series and the annual International Academic Detailing Conference,alongwith facilitating the development of clinicalmaterials. Arielle received herMaster’s Degree in Public Healthwith a concentration in Health Communicationfrom Tufts University School of Medicine. She has several years of experiencecoordinating Boston‐based elder service programs and teaching evidence‐basedhealthyagingworkshops,andispassionateaboutconnectingotherswithresourcesthatenhancethequalityoflifeandimprovethehealthstatusoftheirfamiliesandcommunities.KristinaStefanini|Communications&EventsAssistantInherworkwithNaRCAD,Kristinafocusesonbuildingstrongerpartnershipsandimproving communication between clinical outreach education programs inNaRCAD’snetwork.ShealsohelpscoordinateNaRCADevents,includingtheannualconference series and trainings. Kristina joined the Division ofPharmacoepidemiology and Pharmacoeconomics in 2017 after receiving herBachelorofArtsinMolecularBiologyandPublicHealthfromBostonUniversityin2017.Kristina is passionate about implementation research, program evaluation,anddrugpolicy.

2017 Conference Speaker Biographies

SameerV.Awsare,MD,FACPAssociateExecutiveDirector,ThePermanenteMedicalGroupSameerisanAssociateExecutiveDirectorforThePermanenteMedicalGroupinchargeofPharmacy,AdultandFamilyMedicine,RiskAdjustedCoding,RevenueCycle,OutsideMedicalServicesandtheOpioidInitiative.Dr.AwsarejoinedthePermanenteMedicalGroupin1993.Inadditiontohisclinicalresponsibilities,heis involved in resident teaching and was the Chair of the Hospital EthicsCommittee.HehasalsobeeninvolvedinMedicarecodingandcomplianceatthemedicalcenterlevel.HewastheChiefofmedicineatourCampbellfacility.HehadbeenamemberofTPMGBoardofDirectorsfrom1997‐2014,andservedasitssecretaryfrom2000to2006.HealsoservedasChairoftheboard’sGovernanceCommitteeandtheViceChairoftheboardfrom2006‐2014.HeiscurrentlytheSecretaryoftheMid‐AtlanticPermanenteMedicalGroupBoard.MarkBounthavong,PharmD,MPHNationalClinicalProgramManager,VAPBMAcademicDetailingServiceDr.BounthavongiscurrentlythenationalclinicaldatamanagerfortheVeteransHealth Administration Pharmacy Benefits Management Academic DetailingService, and a PhD candidate in the Pharmaceutical Outcomes Research andPolicyProgramattheUniversityofWashington.MarkstartedhiscareerattheVeteransAffairsSanDiegoHealthcareSystemasapharmacoeconomicsclinicalspecialist.DuringhistenureattheVA,Markworkedonidentifyingcost‐effectivestrategies and formulary management; directed the PGY‐1 Managed CarePharmacy Residency; and completed a Master of Public Health from EmoryUniversity.

AmyBraddockOwner,AmyBraddockDesignAmyhas20yearsofexperienceasagraphicdesigner.Priortolaunchingherowndesign consulting business in 2005, she worked at Hull Creative Group andPearson Education.Amy helps her clients present their content in avisuallycompellingandaccessibleway,collaboratingwiththemfromconceptthroughtoproduction.Shedesignsawiderangeofprojects,includingbrochures,reports,signage,logos,andadvertisements.KristinD.Brown‐Gentry,MSHealthOutcomesScientist,MagellanHealthKristin has been with Magellan’s Clinical Outcomes Analytics and Researchdepartmentforovertwoyears.AtMagellan,Kristinisresponsibleforevaluatingthe clinical and economic effectiveness of performed interventions. She alsoconductsoutcomesresearch,andhashadsuccesspublishingabstractsinpeer‐reviewed journals. Inaddition,shegeneratespredictivemodels toassistwithidentifying members at risk for future adverse events with the goal ofpreemptivelyimprovingthelikelihoodoftheoccurrenceofthoseevents.PriortojoiningMagellan’steam,KristinworkedasaStatisticalGeneticAnalystwithinthe Computational Genomics Core at Vanderbilt UniversityMedical Center inNashville,TN.

DanelleCallan,MA ProgramManager,UniversityofNewMexico'sHealthSciencesCenterDepartmentofFamilyandCommunityMedicineDanelleisStaffCouncilPresidentfortheUniversityofNewMexicoaswellasaProgramManagerfortheDepartmentofFamilyandCommunityMedicineattheUNMHealthSciencesCenter.ShereceivedhercertificationinacademicdetailingfromNaRCADin2013andhasbeenapplyingherskillsinpracticefacilitationandacademicdetailingonmultipleresearchprojectsforthepastfiveyears.Currentlyshe ismanaging several projects relating to chronic non‐cancer pain (CNCP),cardiovasculardisease(ABC's),coloncancerscreening,whilecoordinatingwithprovidersandcommunityhealthorganizations todisseminateevidence‐basedinformationtoclinicsacrossNewMexicothroughacademicdetailing.Sheholdsaduelbachelor'sdegreeinanthropologyandeconomicswhichshereceivedfromUNM in 2005 and received hermaster's degree in Economics in 2011. She iscurrentlyenrolled in theMastersofLawprogramatUNMwithananticipatedgraduationdatein2020.

PatriciaChan,BScPharm,PharmDClinicalPharmacist,ContinuingMedicalEducationVancouverCoastalHealthBritishColumbiaProvinicalAcademicDetailingServiceDr.PatriciaChan isaClinicalPharmacistwith theBritishColumbiaProvincialAcademicDetailingServiceatVancouverCoastalHealth,specializinginmedicaleducation.SheisaClinicalInstructorintheFacultyofPharmaceuticalSciencesattheUniversityofBritishColumbia.PatriciaearnedherDoctorateinPharmacyfromtheUniversityofWashingtonandherBachelorDegreeinPharmaceuticalSciencesfromtheUniversityofBritishColumbia.Patriciahasextensiveclinicalexperince in the areas of generalmedicine, cardiology, respirology, infectiousdiseases,andemergencymedicine.

AletaChristensen,MPH

BehavioralScientistCentersforDiseaseControlandPrevention

AletaChristensen is aBehavioral Scientist atCDC’sNationalCenter for InjuryPrevention and Control. Ms. Christensen leads work in high burden areas toincrease the capacity of community, local, and state partners to respondeffectivelytothespikesinopioidoverdoses.Herworkisrootedinbuildingandsustaining collaborations across sectors including public health, lawenforcement, and treatment. Ms. Christensen also supports communities ofpractice that aim to facilitate communication and collaborationbetween stateopioidoverdoseprevention efforts related toCDC funded strategies includingprescriptiondrugmonitoringprograms,communityandinsurerinterventions,andpolicyevaluation.Ms.ChristensenhasaMaster’sinPublicHealthfromtheSchoolofPublicHealthatGeorgiaStateUniversity.Herresearchinterestsincludeeffectivemodels for healthcare delivery among vulnerable populations and inhigh‐burdenareas,andacademicdetailing.

StevenA.Crawford,MDCo‐Director,theJamesW.MoldMDOklahomaPrimaryCareImprovementCooperative,H20EvidenceNowCooperativeDr. Crawford is the Legislative Committee Chair and a past‐President of theOklahoma Academy of Family Physicians and has served as the chair of theCommission on Governmental Advocacy of the American Academy of FamilyPhysiciansandasadelegatefortheOklahomaStateMedicalAssociationtotheAmerican Medical Association. He has coordinated OU College of Medicine'sAnnualPrimaryCareUpdatecontinuingmedicaleducationprogramforthelast20years.Dr.CrawfordhaspreviousprivatepracticeexperienceinseveralareasinthestateincludingShawnee,Yukon,MidwestCityandOklahomaCity.In2010,hewashonoredbytheOklahomaAcademyofFamilyPhysiciansasOklahoma'sFamilyPhysicianoftheYear.

EllenDancel,PharmD,MPHDirectorofClinicalMaterialsDevelopment,AlosaHealthEllenleadstheAlosaHealthclinicalmaterialsdesignprocess.Thisprocessincludesdeveloping clinical educator training materials, coordinating a comprehensiveevidence document, and creating a summary brochure or detail aid, patientmaterialsandothersupportingitemsincoordinationwithAlosa’sclinicaladvisorsandconsultants.PriortojoiningAlosa,Ellenhadover10yearsofclinicalhospitalpharmacyexperienceinvariousclinicalandadministrativerolesandsupportedaninternationalpublichealthprojectfocusedonHIVandmalaria.HervariedclinicalandpublichealthexperiencesmergetobringtoAlosaHealthprogramsapassionforsharingbest‐practiceguidelinestofacilitateoptimalpatientcare.AlysonDecker,AGNP,MPHClinicalPreventionConsultant,AcademicDetailerAlysonDecker is aClinicalPreventionConsultant andnursepractitionerwithDiseasePrevention&ControlattheSanFranciscoDepartmentofPublicHealth.Astheleadacademicdetailer,shehelpeddevelopSanFrancisco’sfirstHIVpre‐exposure prophylaxis (PrEP) detailing program.Her role consists of detailingwith community providers to increase PrEP prescribing in the primary caresettingandpromotebestprescribingpractices.Inaddition,sheprovidestrainingassistancetohealthcareprovidersandfrontlinestaffaroundimprovingsexualhealthcareandSTDtestingandtreatment.Shealsoseespatientsatthemunicipalsexualhealthclinic,SanFranciscoCityClinic.CristiFroyman,BSc(Pharm),RPhAcademicDetailingPharmacist,BritishColumbiaProvincialAcademicDetailing(PAD)Service,InteriorHealthAuthority,BritishColumbia,CanadaCristi has worked full time as an Academic Detailer with the B.C. ProvincialAcademicDetailing(PAD)ServicesinceSeptember2009. Shegraduated fromthe University of Saskatchewanwith her Bachelor of Science in Pharmacy in2007,andhascompletedherBasicandAdvancedtraininginAcademicDetailing,as well as facilitated training at a Basic Academic Detailer workshop. CristiworkedasacommunityPharmacistinSaskatchewanandBritishColumbia,priorto joining the PAD team. Currently, she travels throughout Interior Healthproviding education sessions to physicians, nurse practitioners, nurses,pharmacists,specialistsandotherhealthcareproviders. Cristiispreceptorforthe Interior Health Pharmacy Practice Residency Program in Kelowna, whichoffersarotationinAcademicDetailinginPrimaryCare.

CrystalHenderson,PharmD,BCPPSeniorDirectorofBehavioralHealthPharmacySolutionsMagellanRxManagementCrystalhasbeenwithMagellanfor2yearswheresheistheproductownerofthecompany’sacademicdetailingsolutions.Shealsooverseesthecorporatestrategyfor formulary management of behavioral health drugs, develops clinicalpharmacysolutionstoaddressgapsincareforpatientswithmentalillness,andistheSMEforbehavioralhealthpharmacyacrossthecompany.Crystalhas13years’ experience in behavioral health pharmacy across multiple settingsincluding managed care, hospital, academia, clinics, and the pharmaceuticalindustry. She received her pharmacy degree from Florida Agricultural &Mechanical University College of Pharmacy and Pharmaceutical Sciences inTallahassee,FL.Shecompletedherpsychiatricpharmacyresidencyprogramatthe University of Maryland School of Pharmacy. She is a board‐certifiedpsychiatricpharmacist.MargaretJin,BScPharm,PharmD,MSc,CDEAcademicDetailingCoordinator,ClinicalPharmacist,HamiltonFamilyHealthTeam,Hamilton,Ontario,CanadaMargarethasbeenwith theHamiltonFamilyHealthTeamfor10yearsas theacademic detailing coordinator and clinical pharmacist in primary care. SheobtainedherBachelorofScienceinPharmacyandDoctorofPharmacydegreesfrom the Faculty of Pharmacy, University of Toronto. She also obtained herMasterof Science inHealthResearchMethodology fromMcMasterUniversity.ShehasalsoworkedwiththeCentreforEffectivePracticeasanacademicdetailerandcontentdeveloperfortheAppropriatePrescribingDemonstrationProjectinLong‐TermCare.

AmandaKennedy,PharmD,BCPSDirector,VermontAcademicDetailingProgram,OfficeofPrimaryCare,UVMAmandahasdeliveredAcademicDetailingsessionstoover700participantssince2003. Amanda regularly serves as a faculty facilitator for NaRCAD AcademicDetailingTechniquestrainings.AsAssociateProfessorofMedicine,UniversityofVermont,CollegeofMedicine,Dr.Kennedyisaresidencyandfellowship‐trainedboard‐certifiedpharmacist investigator.Shehasextensivetraining inresearchand medication safety through completion of an AHRQ‐funded careerdevelopment award (K08), a graduate certificate in human factors and anexecutivefellowshipinpatientsafety.HerprimarycareresearchhasbeenfundedbyAHRQ,HRSA,theStateofVermont,andlocalhealthplans.SheisapracticingpharmacistattheUniversityofVermontMedicalCenter.

DouglasKrakower,MDClinician‐Investigator,DivisionofInfectiousDiseasesBethIsraelDeaconessMedicalCenterDr.Krakower isamemberof theDivisionof InfectiousDiseasesatBethIsraelDeaconessMedicalCenter,aResearchScientistattheFenwayInstitute,andanAssistant Professor in Medicine and PopulationMedicine at HarvardMedicalSchool.HisresearchfocusesonwaystooptimizeHIVpreventionincaresettings.Currently, he is conducting NIH‐funded studies to enhance patient‐providercommunication and clinical decision making regarding the use of HIV pre‐exposure prophylaxis. His clinical practice encompasses general infectiousdiseasesandHIVtreatmentandprevention.

JingLuo,MDInstructorofMedicine,HarvardMedicalSchoolFaculty,DivisionofPharmacoepidemiologyandPharmacoeconomicsBrigham&Women’sHospitalDr. Luo graduated fromDukeUniversity and theUniversity of Illinois at ChicagoCollegeofMedicine,wherehewasanNIH‐FogartyInternationalClinicalResearchScholar.HetrainedinPrimaryCareInternalMedicineatYale‐NewHavenHospital.HeobtainedaMastersofPublicHealthat theHarvardT.H.ChanSchoolofPublicHealth aspart of a generalmedicine fellowship.He isBoardCertified in InternalMedicineandservesasanassociatephysicianatthePhyllisJenCenterforPrimaryCare at BWHand atHarvardUniversityHealth Services.His research focuses onprescriptiondrugpricing, access tomedicines and generic competition.Dr. Luo’swork has appeared in JAMA, JAMA Internal Medicine, Lancet Diabetes &EndocrinologyandtheHarvardHealthPolicyReview.Dr.LuoalsoservesasaclinicalconsultanttoAlosaHealth,anon‐profitorganizationthatpromotesevidence‐basedprescribingandacademicdetailing.

TanyaMarshall,BScPharm,PharmDClinicalPharmacist,ContinuingMedicalEducation,FraserHealthAuthorityBCProvincialAcademicDetailingServiceDr.TanyaMarshallhasahospitalpharmacybackgroundwithareasofpractice ingeneralmedicine,pediatrics,oncology,surgery,psychiatryandemergencymedicine.ShereceivedaBachelorofScienceinPharmacyfromtheUniversityofManitobaandaDoctorofPharmacyDegree fromtheUniversityofWashington.Tanyahasbeenwith the British Columbia Provincial Academic Detailing Service since 2012,providing medical education on seven different topics to family physicians andhealthcareproviderswithintheFraserHealthAuthorityregion.

MeganB.McCullough,PhDInvestigator,ResearchHealthScientist,CenterforHealthcareOrganizationandImplementationResearch(CHOIR),ENRMVeteransMedicalCenterDr.McCullough has beenwith theVeteransAffairsHealth ServicesResearch and(CHOIR)foroverfiveyears.Sheisanexpertinqualitativeresearchmethodsanddataanalysiswithaninterestinpharmacypractice.Currently,Dr.McCullough’sresearchhas focused on the intersection of implementation science and pharmacy. Herpublicationshave contributed to thedevelopmentof implementation scienceandresearch on pharmacy practice and practice change in clinical pharmacy. She isworking on a de‐implementation project to reduce the use of antipsychotics innursinghomesamongresidentswithdementia.SheisalsothePrincipleInvestigatoronamajorevaluationofthedeploymentofclinicalpharmacyspecialistsacrossruralareasintheU.S.toaddressissuesofaccess,painandmentalhealthfortheVHA.

DeborahMonaghan,MDPublicHealth/AcademicDetailerColoradoDepartmentofPublicHealth&EnvironmentDeborah joined CDPHE in 2016 as the department’s first detailer and currentlyprovidesclinicaloutreachonHIVpreventionandsexualhealth.AgraduateoftheUniversity of Mississippi School of Medicine, internship took Deborah to DrexelUniversityinPhiladelphia,Pennsylvania,followedbyresidencyatStMary’sHospitalinGrandJunction,Colorado.ShewillcompleteherMSPHthroughtheUniversityofLondonSchoolofHygieneandTropicalMedicinein2018.Initialresponsefromtheprovider community receiving detailing has been overwhelmingly positive, andDeborah hopes to facilitate expansion of detailing efforts into other branches ofpublichealthtoimpactmoreColoradans.

RobertMorrow,MDAssociateProfessor,DepartmentofFamilyandSocialMedicineAlbertEinsteinCollegeofMedicineBobisafamilypracticephysicianinindependentpracticesince1980intheBronx,and has been involved in leading community based, patient centered researchinvolving coalitions of stakeholders and patients. He has a research interest inContinuingEducationintheHealthProfessions,andhaspublishedseveralresearcharticlesoneducationandnetworkingasatoolforimprovedpatientoutcomes.Hecurrently iscollaboratingwithHealthPeople[acommunity‐basedpeereducationorganization],QTAC[TheQualityandTechnicalAssistanceCenterofNY]oftheStateUniversity of New York at Albany, and other groups to bring diabetes self‐managementtotheSouthBronxandYonkers,usinglinkednetworksofcommunitycoaches, academic detailers in health teams, and public health implementationexperts.

AronNenninger,BScPharm,RPhAcademicDetailingPharmacist,BritishColumbiaPADClinicalPharmacist,NorthernHealth,Terrace,BC,CanadaAronhasworkedwiththePADacademicdetailingteamsince2010,splittinghistimebetween academic detailing and hospital based clinical pharmacy. He finds thiscombined position very useful, getting to apply what he learns and teaches inacademicdetailingtoacutecarepatients.AfterearninghispharmacydegreefromtheUniversityofAlberta,heworkedinretailpharmacyfor12yearsbeforejoiningPAD,bringingexperiences in effectively communicatingwithpatients. Whennotworking,Aronenjoyssports,playingpiano,andisaCANSILevelOnecertifiedCrossCountrySkiinstructor.

SarahJ.Popish,PharmD,BCPPNationalClinicalProgramManager,VAPBMAcademicDetailingServiceClinicalPharmacySpecialistMentalHealth,SarasotaVAClinicDr. Popish is currently a Program Manager for Veterans Affairs Central Office,PharmacyBenefitsManagement,AcademicDetailingProgramofficewhichservicesthe growing Academic Detailing programs throughout Veterans HeathAdministration(VHA).Inaddition,shespends10%ofhertimeasaMentalHealthClinicalPharmacySpecialists fortheBayPinesVAMedicalCenter.AfterreceivingherPharmDfromtheUniversityofColorado,SchoolofPharmacy,shewentontocomplete aPsychiatricPharmacyResidencyaffiliatedwith IdahoStateUniversityCollegeofPharmacyandatwo‐yearPharmacogenomicsandPsychopharmacologyResearchFellowshipwithNovaSouthEasternUniversityandLakeErieCollegeofMedicine. Over the last seven years Dr. Popish has developed or assisted in thedevelopmentofmultipleAcademicDetailingproviderguidesandpocketcardsthatareusedonanationallevelbyVHA.

AddisonRagan,PharmD,BCPSAcademicDetailingProgramManager,VHAVISN7(AtlantaNetwork)AddisonworksfortheVeteransHealthAdministrationwhereshedirectstheVISN7AcademicDetailingProgramandservesasanacademicdetailer forVAprovidersacross Alabama and Georgia. She earned her Doctor of Pharmacy Degree fromAuburnUniversityinMay2000andstartedworkingattheVAasaClinicalPharmacySpecialistinPrimaryCare.SheservedastheAssociateChiefofClinicalPharmacyfortheCentralAlabamaVAHealthCareSystemforeightyearswithafocusonexpandingclinical pharmacy practice. Dr. Ragan partners with the VA National AcademicDetailingProgramOfficetotrainandmentoracademicdetailersandcurrentlyservesasapreceptorforpharmacystudentandpost‐graduatetrainees.

NadejdaRaziRobertson,LCSW,PhDBehavioralHealthConsultant,PracticeFacilitator,OregonHealthAuthorityNadejda is currently working as a member of Oregon’s Pain ManagementImprovement Team (PMIT) as a practice facilitator. PMIT provides TechnicalAssistance to health care organizations for the OHA Prescription Drug Overdose(PDO)Preventionproject,supportinghealthsystemstoenhanceinternalcapacityfor a team‐based approach to chronic pain and/or opioid management. Shespecializesinsupportinghealthsystemsinfindingthedelicatebalanceofprovidingcompassionate care and establishing boundaries that enable safe and effectivetreatment of chronic pain and use of opioids. Nadejda is also on the steeringcommitteeof theOregonPainGuidanceGroupandworks inprivatepracticeasatherapist.

LorenRegier,BA,BSPProgramCoordinator,RxFilesADServiceLoren has lead the RxFiles Academic Detailing service in Saskatchewan for 20years. HeearnedhispharmacydegreeattheUniversityofSaskatchewanin1988andcompletedahospitalpharmacyresidencyin1989.LorenalsoprovidesclinicalpainmanagementconsultationsfortheFITforActiveLivingProgramatSaskatoonCityHospital.Lorenhasbeeninvolvedinavarietyofaspectsofacademicdetailingincluding resource development, evidence synthesis, program management anddesignaswellastheactualdaytodaydetailing.From2015‐17healsoservedaspart‐timeco‐directorfortheCEPAcademicDetailingService,providingtrainingandmentorshipfornewdetailersinvolvedindrugtherapydiscussionsinlong‐termcare.

RobertRhyne,MDCo‐Director,ResearchCoreistheViceChairofResearchProfessor,FamilyandCommunityMedicineDepartment,UNMRobertRhyne,MDisaProfessorandViceChairforResearchintheDepartmentofFamilyandCommunityMedicineattheUniversityofNewMexicoSchoolofMedicine.In addition, he is the co‐founder of the practice‐based research network in NewMexico,ResearchInvolvingOutpatientSettingsNetwork(RIOSNet).Hehasover40yearsofexperienceinprimarycare,andsince1984hasbeencontinuouslyfundedwithgrantsupportforresearch,andhasbeenPIandco‐investigatoronmultipleNIHand AHRQ funded projects. His research focuses on health disparities, evidencebasedmedicine,translationalpracticebasedresearch,andpreventivemedicine.Hisresearch topics include colorectal cancer screening in multiethnic populations,qualityimprovementinsmallprimarycarepracticeswithregardtocardiovascularprevention,andthetreatmentofchronicnon‐cancerpain,specificallywithrespecttoopioidprescribing.

BrendaSchuster,BSP,ACPR,PharmD,FCSHPAcademicDetailer,RxFilesADServiceBrendaSchusterisanacademicdetailerwiththeRxFilesAcademicDetailingServicein Regina, SK, Canada, and a training facilitator for NaRCAD's 2‐day academicdetailingtechniquescourse.Brendahasbeenprovidingacademicdetailingservicesforthelast16yearsandshecombinesthiswithherclinicalpracticeattheAcademicFamilyMedicineUnit. She is involved in teaching familymedicine residents andworksalongsidethemtoassistintheirdailyprescribingdecisions.SheisaClinicalAssistant Professor with the College of Pharmacy and Nutrition, University ofSaskatchewanandapreceptorforhospitalpharmacyandprimarycarepharmacyresidents.BrendahasbeeninvolvedinfacilitatingacademicdetailingtrainingsforRxFiles on new topics and has co‐facilitated academic detailer training skillsworkshopsforacademicdetailersinCanadaandtheUnitedStates.

DonTeaterMD,MPHOwner,TeaterHealthSolutionsDonisafamilyphysicianwhohaslivedandworkedinwesternNorthCarolinaforthe past 29 years. Since 2004 he has focused more on the intersection of pain,opioids,andaddiction.Dr.Teaterwasleadfacilitatorfortheexpertpanelduringthedevelopment of the CDC Guidelines for Prescribing Opioids for Chronic Pain. Hecontinues towork as a consultantwith the CDC on educating prescribers on theappropriatetreatmentofpain.Whileworkingnationallyonthepublichealthaspectsoftheopioidepidemic,hecontinuestoseepatientsonedayaweektreatingopioidusedisorderandchronicpaininWaynesville,NC.SkyeTikkanen,MS,CSAC,LPC,ICS‐ITDrugPoisoningPreventionProgramManageratSafeCommunitiesSkye is the Director of DrugPoisoning Prevention at Safe Communities andatherapistatConnectionsCounseling,LLC.Shespecializesinworkingwithteensandyoung adults suffering from opiate dependence. She was the chair ofSCAODA's Ad Hoc Committee on 911 Good Samaritan Legislation, serves asanadviserfortheParentAddictionNetworkandhascontributedherownstoryofrecoverytoWakingUpHappy:AHandbookofChangewithMemoirsofRecoveryandHope.

JackiTravers,PharmDClinicalAcademicDetailingPharmacistPharmacyManagementConsultantsJackijoinedPharmacyManagementConsultants(PMC)in2015astheirfirstandonlyacademicdetailingpharmacist.Shehasbeenactiveinthedevelopmentandimplementation of PMC’s academic detailing program as part of its service toOklahomaMedicaid.PriortojoiningPMC,sheservedinthepracticesettingsofindependent, hospital, and clinical pharmacy. She received a BS from theUniversityofColorado,andaDoctorofPharmacydegreefromtheUniversityofOklahoma.Herprogrameffortsfocusonbridgingthegapbetweeninformationandapplicationtoprovidequalityhealthcareinafiscallyresponsiblemanner.

CorefundingforNaRCAD&theADConferenceSeriesismadepossiblebytheAgencyforHealthcareResearchandQuality.OurconferenceserieswasalsomadepossiblebygenerosityfromtheDivisionofPharmacoepidemiology&Pharmacoeconomics

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“Who Do You Trust? Navigating a Disorienting Healthcare Landscape” JerryAvorn,MD,NaRCADCo‐director|DETAILSBLOG,2017

First,aboutthegrammar.Readersunder65willbe forgiven iftheyneverheardof thedaytime televisionquiz show“WhoDoYouTrust?” that aired from 1957 to 1963. In it,male contestantswereaskediftheywantedtoansweraquestionorwhetherthey‘trusted’theirwifetodoso.Concernsbysnarkylittlekidslikemethatitreallyshouldhavebeen“WhomDoYouTrust?”didnotdiminishtheshow’spopularappeal.Genderissueswenttotallyundiscussed.

Allgrownupnowandconfrontingachanginghealthcarelandscape,that still‐sometimes‐snarky little boyoftenwonders,asdomanyofmycliniciancolleagues,whocanbe trusted in the world of medical information,especiallyinrelationtoprescriptiondrugs.Gonearethesimpler times when one had to worry only aboutwhether the drug ads and sales reps were reallypresentingabalancedpictureofalltheevidence,whichwasahardenoughchallenge.

Wenowknowthatwealsohavetobeconcernedaboutoff‐labelmarketingcampaignsofferingimpermissible(andoftendownrightdeceptive)statementsaboutefficacy– excesses forwhichover$16billionhasnowbeenpaidtostateattorneysgeneralandotherplaintiffsinlegalpenaltiesandsettlements.

As I’ve noted previously, the courts and the FDA are also moving toward much morepermissivenesswithcompanyclaimsaboutefficacyandsafety.And in lastyear’s21stCenturyCuresAct,Congress instructedtheFDAtobemoreopentoaccepting lowerstandardsfordrugapproval.

Then there are newer sources of information whosetrustworthiness is not always clear. More and more, thisincludes theprescription benefit management (PBM)companies, which seem to be holding on to an ever‐largerfraction of the funds flowing through their rich paymentpipelines, yet provide little transparency aboutwho gets tokeepwhatrebatedollars,andforwhatreason.Oncebilledascost‐savingsprotectorsandcomparativeeffectivenessgurus,

thePBMsareunderincreasingscrutiny,andaskedtomaketheirfinancialdatatransparentandtoclarifyjustwho’ssavingwhatforwhom(orisit‘forwho?’).Norcanwealwaysbesurewhatanglethepayorsareplaying.WhyisDrugAontheformulary,butnotitssiblingDrugB?Itmaybeanastutepurchasingdecision,orjusttheresultofarebatehack.And how much are prior authorization rules and growing co‐payments designed to promoteevidence‐based care, or other less worthy goals? Even clinical guidelines put out by thirdpartiesvaryfromthemostrigoroustoprettysketchy.

This leadstoonegoodanswertotheungrammaticalquestioninourtitle.Withthesegallopingchanges inanever‐moremarketplace‐orientedhealthcaresystem,everyprescriberneedsanddeservesasmart,superblyinformedcolleaguetorelyontogetthebestpossiblesynthesesoftheclinicalevidence–someonewhohasnootheragendaormotivationotherthangettingthefactsrightandtransmittingthemfaithfully.Each year, we can take less comfort incounting only on FDA‐approved indications,or payor policies, or PBM choices, oradvertised claims. The more compromisedeachofthesesourcesbecomes,themorewe’llneed ‘honest brokers’ likewell‐trainedandun‐conflictedacademicdetailers,whoseonlyduty is to communicate the fairest evidencesummaries as effectively as possible. Likelightweight clothing in an era of globalwarming, it’s a need that’s only going toincrease.

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Sharing Stories: HIV PrEP Detailing in San Francisco for CDC Project PrIDE GuestBlog|AlysonDecker,NP,MPHSanFranciscoDepartmentofPublicHealth|DETAILSBLOG,2017

OurADprogramispartofa3‐yeardemonstration project (CDC ProjectPrIDE),and as part of our grant‐fundedwork our overarching goal is increasingPrEPaccessandprescribingtoMSM(menwho have sex with men) of color andtransgender persons who are atsubstantial risk of acquiring HIV. Ourgoals include improvingsexualhealth in

theprimarycaresetting,refiningsexualhealthhistory‐taking,increasingscreeningandtestingforthose with risks, promoting best practices around PrEP prescribing, and helping to establishrelationshipsbetweenourhealthdepartmentandourcommunityproviders.Theaddedbenefitofpublichealthdetailingisthatitalsoincreasesawarenessabouttheissuesthat affect our community. I have been inviting clinicians that I meet to join us in our city‐wideGettingtoZeroconsortium,whichhelpsprovidersfeelthattheyarepartofthisimportantmovementofpreventingHIVtransmissions,deaths,andstigma. In SanFrancisco, there is aneed forurgencyaround this issue, especiallybecause it’s becomeevidentthatasHIVtransmissionscontinuetodecrease,thedisparitiesamongnewHIVpositivediagnosesbecomemoreapparent.ManyofthesedisparitiesareamongcommunitieswhostillmaynotbeawareofPrEP,orarefacingbarrierstoaccess.Ouracademicdetailingprogramstrivestoreachtheproviderswhoworkwiththesevulnerablecommunities.When kicking off an intervention such as this, identifying theclinicianswhoseethistargetpopulationisthefirststep.Todothis, we used STD surveillance data to determine whichproviders and clinics were diagnosing syphilis and rectalgonorrhea and chlamydia, which are associated with anincreasedriskforHIV.However,sincemanyprovidersarenotperforming appropriate screenings, we also reached out toclinicsknowntoserveourprioritypopulationandthoselocatedinneighborhoodswiththehighestHIVincidences.Thenextstepishowto“getinthedoor”withtheseclinicians,whichmeansfindingawaytosecurea1:1visit.I’vefoundthatinitialnon‐responsivenessisn’ttheendoftheworld—persistencepaysoff,sokeeptryingtogetinthedoor,orfindanentrypointthroughothercommunitycontacts.Sometimes,choosingadifferentaccesspointcanreallyworkwelltostartarelationship.Therearemanyplaceswhere1:1visitsaren’tfeasibleduetoclinicstructureorculture.IfI’mabletodetailtoasmallgroup,itcanbeawaytomeetwithafewprovidersandgaininsightabouthowPrEPmightbeincorporatedorenhancedintheirsetting.

Being invited to an all‐staffmeeting is often an excellentway to kick off an introduction to this importantintervention, and can result in follow‐up conversationswithindividualclinicians.OnebenefitofmeetinginsmallgroupsisthatifaclinicianhearsafellowcliniciansaythatheorsheisalreadyprescribingPrEP,theremaybemoreopennesstodiscussingthetopic;otherprovidersmightfeelcomfortedinhavingaPrEP"ally",resultinginbuy‐infromtheclinicoverall.

Some clinicians may think that this type of interventionisn’t relevant to their patient population; as I detailer, Ioftenhearresponsessuchas, “Idon’t see thispopulation

reflectedinmypractice,”or“Mypatientsdon’thavethisrisk,”,evenifit’sbeenproventhattheseclinicsdo,indeed,serveprioritypopulations. InordertotalkaboutPrEP,youfirsthavetotalkaboutrisksforHIV,whichoftenmeanstalkingaboutsex.Ithinktherecanbediscomfortonboththepatientandproviderside,andsexisoftenstillastigmatizedtopic.Therearealsooverarchingresource barriers, including the fact that clinicians are extremely busy and have to addresscompetinghealthneedsintheprimarycaresetting.

WhileasmallpoolofclinicianshaveminimalunderstandingofPrEP,andrequireabasicoverviewaboutelementslikeidentifyingpotentialPrEPcandidates,howtotakeagoodsexualhistory,andhowtobringupPrEPinanappointment,I’vefoundthatmanycliniciansareawaretosomeextentaboutPrEPalready,andareinterestedinnext‐leveldetailsabouthowtoimplementit.Thismightinclude what kind of testing is recommended, how to increase number of basic screens, andincreasingtheirknowledgeaboutcomprehensivehealth.There are also providers who are very advanced in theirknowledgeofwhatoptionsareavailabletopopulationswithrisksforHIV.Thisiswheretheacademicdetailingbecomesmore intricate; some providers are seeing lots of patientswith risk factors, and may have been prescribing PrEPalready. In a scenario such as this, mymessaging focusesmore on how to support clinicians in ensuring consistentfollow‐upwiththeirpatients,orinhowtodealwithmultiplerisk factors, such as when high‐risk sexual behavior mayoverlapwithinstancesofsubstanceuseorhomelessness.

For thosewho are just getting started, itmay help to know that even aftermeetingwith 300providers, I still get nervous each time I prepare to detail, especially if I’m unfamiliar with apractice. Regardless of the nature of my visits, I walk away feeling that I’ve accomplishedsomethingifI’veansweredonlyonequestionthat’shelpedtheclinicianwithhisorherpractice.AndI’vefoundthatinmostcases,thepeopleImeetwithareverythankfulforthisservice,andareappreciativeofthehealthdepartment.Ialwaysthankprovidersfortheworktheydoandremindthemwhatanimportantroletheyhaveinthecommunity.

Learn more abouttheinterventionsthatareshapingthefieldofAD.Searchourblogarchivesbyclinicaltopic,orvisitourLearningCenterforexamplesofmarketingmaterials.

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Just Do It: Diving into Detailing YearOneofColoradoDepartmentofPublicHealth&Environment’sProgramGuestBlog|DeborahMonaghan,MD|NaRCADTrainingAlumnusColoradoDepartmentofPublicHealth&Environment|DETAILSBLOG,2017

As the firstandonlydetailer hired bytheColoradoDepartmentof Public Health andEnvironment, whichserves5.6millionpeople(about3millionofwhichclusteraroundonemetroarea),theideaofbuildingadetailingprogramfromthe ground up wasincredibly exciting… anddaunting. From theoutset, it was importanttodeterminetheplaceofdetailing within thecommunityandestablishitsfitinthedepartment’smission.

Shortlyafterjoiningtheteam,Ipresentedtheintendedscopeofmyworkatadepartmentmeeting,anditgeneratedtremendousinterestintheuseofacademicdetailingforpublichealthinitiativesfarbeyondthecurrentplannedintervention.Thisservedtosolidifythepotentialvalueofclinicaleducation outreachto leadership throughout the department. Lessons learned are continuallysurfacingaswemoveintoyeartwo,andafewkeyconceptsareworthsharing.Particularly in theearly stagesofprogramestablishment, itwasessentialtostretchresourcesandleveragepartnerships.NaRCADconnectionswithotherdetailingprogramsfacilitatedtheexchangeofprintresources,protocolsandlessonslearned,savingvaluabledevelopmenttime.ThroughCDC‐fundedcapacitybuildingvisits,Ishadoweddetailingteams at two other health departments' AD programs(SanFrancisco Department of Public Health and theNew York CityDepartment of Health & Mental Hygiene),which provided aframeworkforourownprogram’sfunction.Ateveryopportunity,Ipresentedourdetailinggoalstocommunitypartnersandstakeholders, resulting inmanyconnections tomedicalproviders,which, in turn,generated most of our initial provider visits. Submitting articles for local clinical practicenewsletters andmagazines also established recognition and trust in the state’s new detailinginitiatives.

Onceprovider‐facingdetailingvisitsbegan,twothingsbecamequiteclear:Providers crave connection to their public health department.

Providers want regional data. Inastatewithbothurbanandrural/frontierareas,urbanclinicianswantedtobeseenas“bootsontheground” to impact large populations by treatingtheirownpatients,whileruralproviderswantedto be acknowledged as part of the team anddirectedtoresourcestheycouldaccessremotely.All clinicians, both urban and rural, wanted thelatestdiseaseandhealthdatafortheircounty,zipcode,andevencensustractleveltocomparetotherestofthestate.Ithastakenmultipleattemptstogetinthedoorinmanypractices.However,afteradetailingvisit,most providers are outspoken that they found the session worthwhile, and we've used thisopportunity to ask for referrals to other providers who might be open to visits. The timeinvestmenthasalsoenabledtwo‐waycommunicationallowingustogeta“fingeronthepulse”ofregionalhealthanddisease,particularlyinthemoreruralareas.

Theinitialtimeinvestedtoestablishrelationshipswithproviderswashigh,buttherateofreturnhasjustifiedtheinvestment.Withanewdetailingprogram,theresponsibilityfallstothedetailertoestablishcredibility,bothinresourcesprovidedaswellasinvaluefortimespent.

IfIwerestartingadetailingprogramagain,orcouldsupportnewprogramswhowerejustgettingstarted,Iwouldlovetobearmedwiththeselessonslearned:

Establishasmanyprotocols,proceduresandresourcesaspossible.

Juststart!Evenifeverydetailisn’tinplace,startvisitingwithproviders.(Thesteeplearningcurveofon‐the‐groundvisitsis

incrediblyvaluableandwillcontinuetoshapeandimproveyourmethods.)Documenteverything!Asmethodschangeandprocessesimprove,documentwhatischangingandwhy.Documentwiththegoalofsharingnotsimplyastartingpointandafinishedproductbutanentirestory.Bewillingtoadjustinrealtime.Providerswillhavevaryingneedsfromonetoanotherandfromonedaytothenext,andourflexibilitywillultimatelystrengthentherelationshipswearetryingtobuild,allowingacademicdetailingtohavethegreatestpossibleimpact. 

Next month on our blog: You. No,really.Wewanttoshareyourstorywithournetwork.Tellusaboutyourchallengesandsuccesses

withyourlatestclinicaloutreacheducationintervention.E‐mailBevintogetstarted.bshagoury@partners.org 

Illustrating Value, Prioritizing Evaluation, Saving Lives: TheNationalAcademicDetailingService’s  OpioidOverdoseEducation&NaloxoneDistribution(OEND)ProgramGuestBlogAuthors:MelissaChristopher,PharmD&MarkBounthavong,PharmD,MPHVeteransHealthAdministration|DETAILS2017

The Department of VeteransAffairs(VA)investedintheNationalAcademic Detailing Service toimprove thehealthofourVeteranstoaddress thecall toactionfor theopioid crisis.Through the Opioid

OverdoseEducationandNaloxoneDistribution(OEND)Program,ourgoalsweretoreduceharmandriskoflife‐threateningopioid‐relatedoverdoseanddeathsamongVeterans.KeycomponentsoftheOENDprogramincluderaisingawarenessabouttheepidemic,1:1academicdetailingvisitswithclinicianstoprovideeducationandtrainingregardingopioidoverdoseprevention,opioidoverdoserescueresponse,andissuingnaloxoneproducts.Wedevelopeddirect‐to‐consumermarketingandothere‐resources,includingavideo,IntroductiontoNaloxoneforPeopleTakingPrescribedOpioids.Wealsocreatedimplementationtools,includingpopulationmanagementdashboardstoaidstaffinevaluatingriskfactorsoftheirpatientpopulationanddistributingnaloxoneaccordingly.AcademicDetailersdemonstratedtoVAproviderstheseresourcestohelpraiseawarenessofopioidoverdoseriskfortheirpatientpanel.Decision‐makers believedthat funding this programwould yield a good returnon investment. As part ofthe National AcademicDetailing Service, it’s ourresponsibilitytocollectdataandsupplydecision‐makerswith evidence on the valueandsuccessofourprogram.In other words, we’reaccountable for answeringthequestion:“Isacademicdetailingworthit?”Toanswerthisquestion,weperformedseveralprogramevaluationsoftheNationalAcademicDetailingServicefrom2015to2017,oneofwhichwejustpublishedintheJournalofAmericanPharmacistsAssociation(JAPhA)(“TrendsinnaloxoneprescriptionsprescribedafterimplementationofaNationalAcademicDetailingServiceintheVeteransHealthAdministration:Apreliminaryanalysis.”—toreview,pleasevisitnarcad.orgforlivelinksinthisblogarticle.)

The evaluation found thatour program improved naloxone distribution ratesat a seven timesgreater increase forVeteransat risk foropioidoverdose.TheseresultsprovidedkeyempiricalevidencethatVA’sstrategyofacademicdetailingwasworking.Justasimportant,thesefindingsalsogavedecision‐makerswhattheyneeded—proofthattheirinvestmentinanareaofhighrisktoVeterans’healthpaidoffbyimprovingcare.

But we learned that another group ofstakeholderswas just as important as thedecision‐makers who funded theprogram—the clinicians that academicdetailers visited to provide outreacheducationasa service.Academicdetailersworkwith clinicians to help them changepractice patterns, focusing on improvinghealth outcomes in alignment withbalanced,currentevidence.

Asclinicianscommittosustainablebehaviorchange,theseprovidersneedtohearthefeedbackabouthowthetimethey’veinvestedwiththeirpatientsultimatelyimprovesoutcomesand,inthiscase,saveslives.

Sharingprogramresultswiththecliniciansinthisinterventionalsoencouragedtheseproviderstosharetheirownresults,manyofwhichwerestoriesofpatientsreturningtotheclinictorelatetheir experiences of using naloxone to reverse an overdose.These stories, alongwith reversalreportsfromthefieldthattrackedtheoutcomesofnaloxonekitdistributionandsubsequentuse,alsocreatedatangible“returnoninvestment”foreveryoneinvolved.WeencourageotheracademicdetailingprogramstoprioritizeprogramevaluationaswehaveattheVHA—nomatterthesizeof your program, if you’re thinking, “we can’t afford to doprogramevaluations,“westressthatyoucan’taffordnottodothem.Measuringprogramworkbuildsacasenot justforthesuccess of one academic detailing intervention, but for thesuccess of future programs—a case for sustainability.Evaluation measures the quality of a program, analyzingresultstolookataprogram’simpact,andallowingforprocessimprovementadjustmentstobemadetostreamlineeffortsandstrengthenthatimpact.Evaluationcannotbeoptional,especiallywhenlivesareatstake.

Wealsorecommendthattheresultsfromprogramevaluationsaresharedwithotherstakeholders,suchasclinicians, inordertoencourageandsustaintheirbehaviorchanges.Leveragingresultsfrom well‐designed evaluation is essential for academic detailing interventions to illustratesuccess,sharevalue,andprovidestakeholdersandcommunitymemberswithaclear“Yes!” inresponsetotheiroverarchingquestion:“Wasthisinvestmentworthit?”

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