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Roar Dyrkorn Head of Project Academic Detailing
Spec. in Clinical Pharmacology and Family Medicine
Dept. for Clinical Pharmacology
St. Olavs Hospital, Trondheim , Norway
Representing:
THE CHALLENGE !
GPs are drowning in therapeutic guidelines !
With permission: Bjarne Alstad
Clinical
Guidelines:
ca. 100 pages
Addictive
drugs
Clinical
Guidelines:
ca. 6
20-40 pages
each
Rheumatology
Clinical
Guidelines:
30 pages
Obestias
Clinical Guidelines in our National Health Library www.helsebilblioteket.no
and others who want to have influence on medical practice
Psychiatry
Clinical
Guidelines:
16
20-150 pages
Expert groups
and «task
forces»
Patient
organizations
Industrial
sponsors
Diabetes
Clinical
Guidelines:
124 pages
Expert groups
and
«taskforces»
Patient
organizations
Industrial
sponsors
Hypertension
Clinical
Guidelines:
«numerous»
Expert groups
and «task
forces»
Patient
organizations
Industrial
sponsors
Muscle- and
Skeletal
disorders
Clinical
Guidelines:
ca. 20
20-100 pages
Expert groups
and «task forces»
Patient
organizations
Industrial
sponsors
Osteoporosis COPD and
Pulmonary
Clinical
Guidelines:
12
20-190 pages
Expert groups
and «task
forces»
Patient
organizations
Industrial
sponsors
Cardio-
vascular
Clinical
Guidelines:
6
18-400 pages
Expert groups
and «task
forces»
Patient
organizations
Industrial
sponsors
IMPOSSIBLE FOR GPs TO BE UPDATED ON ALL THIS TO ALL TIMES !
And of course; Dear Health Care Provider Letters
Academic Detailing in Norway is called: evidencebased uppdating visits
Since 2006 we have been offering GPs different types of
pharmacological education/training.
Academic detailing started in 2015
Academic Detailing is a one-to-one interactive communication with a
practicing doctor which lasts about 20 minutes during office hours
discussing a therapeutic guideline or f.ex. “Better use of NSAIDs”
Our opinion is that this method is very well suited for personalized
support for good clinical decision-making.
Avd. for klinisk farmakologi
It was Avorn and Soumerai who first introduced the method
Academic Detailing through an article in NEJM in 1983
Their idea was no rocket science, but they showed that it
worked
”Think if we could use the communication - and
marketing skills of the pharmaceutical industry to present
independent and evidence based knowlegde to practicing
doctors in their own practices”
AUSTRALIA, since 1999
Independent Not-for-Profit Evidence Based
Our programs are funded by the Australian Government,
Department of Health and our members
Educational Visiting Service Delivery in Australia
•1991 DATIS commenced in Adelaide, South Australia
• 1999 NPS national programme
• greater than 70% of GPs in Australia have participated
•Approaching 250,000 visits conducted Australia wide
•Approx 25,000 health professionals participate each year
•Three programmes offered per year
Academic Detailing in Norway
• Since 2012 we have been studying the method Academic Detailing at:
• The Drug and Theraputic Information Service, DATIS, in Adelaide
• The National Prescribing Service, NPS, in Sydney
• The National Resource Center for Academic Detailing, NaRCAD in Boston
• I visited Debra Rowett and the National Prescribing Service for 6 weeks and
attended their seminars and visits to local GPs
• We also attended seminars and workshops at The National Resource Center for
Academic Detailing, NaRCAD, in Boston, USA
• Academic Detailing is also used in Canada, Brasil and India
• And in Norway we gradually worked towards our health authorities to introduce the
method Academic Detailing in Norway
• In January 2015 we got funding to start our first campaign and Debra Rowett came
to Norway to educate 20 clinical facilitators
Which goals do we have?
• We want to use AD to:
Maintain and eventually increase GPs phamacological
competence to avoid harm amongst their patients
Background
NSAIDs are one of the most widely used classes of drugs worldwide
and are used to treat common conditions such as pain, fever and
headaches.
For years, regulators have known about increased risk for heart
attack and stroke from NSAIDS, especially when taken in high
doses for prolonged periods.
Then in 2004 and 2005, two high-profile drugs, Merck's Vioxx and
Pfizer's Bextra, respectively, were pulled from the market due to
increased risk for heart attack and stroke.
Dear Health Care Provider Letters:
Improving Communication of Important Safety
Information; do not seem to have the Desired Impact???
Interpretation The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to
coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although
NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which
could help guide clinical decision making.
Funding UK Medical Research Council and British Heart Foundation.
Serious cardiovascular events Serious coronary events Serious G/I – adverse events
«Better use of NSAIDs» was our first campaign
We visitied 213 of 247 GPs in the cities of Trondheim and Tromsoe
during February, March and April 2015 and 169 answered a Questback
after the visit
98 % answered that they got useful information about NSAIDs
99 % answered that the topic was relevant for their practice
92 % said that they would to a great or a certain extent change their
practice when prescribing NSAIDs
90 % considered Academic Detailing as a very suitable method for
producer independent and evidence based information
98 % said that they would be happy to receive a new visit on another
topic
Avd. for klinisk farmakologi
Collecting data
We used The Prescription Database to collect data on
NSAIDs prescriptions from one year before our campaign
and are going to collect data monthly for one year after
our campaign
This gives us the opportunity to see if changes in
prescriptions are persisting
Avd. for klinisk farmakologi
Results from The Prescription Database
Changes
Diklofenak (inkl. kombinasjoner)
April - June 2014 * April - June 2015 * Change in %
Tromsø 7,2 5,8 -19,0 %
Bodø 10,1 9,5 -5,8 %
Trondheim 8,8 5,7 -35,1 %
Bergen 9,8 9,1 -6,6 %
Norway 9,5 8,9 -6,9 %
* Average prevalence, per 1000, per month
Better use of antibiotics We have visited 455 GPs; Response rate evaluation 73,9 %
96 % ment that 20 minutes were adequate
94 % answered that they got useful information about antibiotics
100 % ment the topic was relevant
67 % said that they would to a great or a certain extent change their
practice when prescribing antibiotics
99 % ment that right choice of antibiotic could reduce bacterial
resistance
97 % considered Academic Detailing as a very suitable method for
producer independent and evidence based information
98,5 % said that they would be happy to receive a new visit on another
topic
Ongoing campaign:
Academic Detailing
The method AD is based on trust and reliable relationships in
one-to-one interactive communication!
As Clinical Facilitators we have to believe that doctors allways
want to do the best for their patients
And the doctors we visit must allways be confident that the
message we deliver is evidence based and producer
independent for the best for their patients
Academic Detailing
Our opinion is that this method is very well suited for risk
communication in the field of medicine
This is how they do it in Australia:
https://www.youtube.com/watch?v=YDxQy-UTZEU
Avd. for klinisk farmakologi