Using the pharma rep model for good
That would be called academic detailing. And it's real!
Pharmaceutical reps are a constant presence in clinics. They’re personable, patient, and persistent, often arriving with samples, food, and branded supplies. Over time, the staff gets to know them, trust them, and value their help. Interactions between reps and prescribers are educational and collegial, but they’re also strategic. And there’s a name for this strategy: pharmaceutical detailing.
Pharmaceutical detailing relies on relationships. Sales reps build one-on-one connections with prescribers while sharing detailed information about brand-name drugs, with the goal of influencing prescribing and growing market share. And, despite the human connection, they’re ultimately funded by drug companies; they’re generally successful because personal relationships shape prescribing decisions in powerful ways.
As I grew in my career and treatment options became more complex, I began to question whether industry-funded reps were the best source of prescribing education. Newer drugs were not always the best choice, yet no one was promoting older, cheaper generics, non-drug therapies, or watchful waiting. (That wouldn’t be a great sales strategy.)
This is when I learned about academic detailing, a practice that uses those same relationship-based tools, but for a very different purpose. Academic detailing is like a “public service version” of drug reps. Instead of selling medications, academic detailers help doctors understand the evidence behind treatment options so they can choose what’s best for their patients. Funded by noncommercial sources such as academic institutions, nonprofits, and government agencies, academic detailing focuses on unbiased, evidence-based care, not product promotion.
To learn more, I spoke with Costadina Aneziris, PharmD, BCGP, clinical content coordinator at Illinois ADVANCE, the nation’s largest academic detailing program at the University of Illinois Chicago College of Pharmacy.
What is the main goal of academic detailing?
At its core, academic detailing is a focused two-way conversation on a health topic between an academic detailer and a healthcare professional. At many programs, including Illinois ADVANCE, the specially trained academic detailers are also clinical pharmacists. The goal is to share updated evidence-based information and key messages that guide prescribing decisions to ultimately improve patient outcomes.
Furthermore, this blossoms into a consistent relationship of information exchange and resource procurement that transcends to support for any barriers being faced in patient care. Types of resources provided include communication tools, community resources, and drug information.
What challenges do prescribers have with keeping up to date with evidence-based prescribing?
There are two notable obstacles to keeping up to date with evidence-based information. The first is the volume of information and updates across health topics, and the second is available time to dedicate to not just learning about these updates, but to translating them to practice.
One study suggests it could take 17 years for these clinical updates to be adopted into practice. Another states a general medicine physician would need to read 17 articles a day, each day of the year, to stay current.
Academic detailing takes the time to understand the needs of the community, which guides the selection of topics, and narrows the focus to actionable key messages that can easily be adopted into practice. This allows us to procure information under that scope and take on the burden of constantly updating as new guidelines, studies, and evidence-based information becomes available. Because the nature of academic detailing is a conversation with open-ended questions, we also constantly receive information about barriers, needs, and common questions from those who participate in the program, which allows us to further tailor the information in our updates and new materials.
As a result of taking all that into consideration, a 20-minute in-person or virtual academic detailing visit can occur and be rich in information that is impactful, but not overwhelming.
Can you give a few examples of how academic detailing led to safer prescribing?
After our education, one health system embedded a prescribing prompt into its EHR so that naloxone is automatically considered whenever an opioid is prescribed. Another is a health system that utilized our education on HIV PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) to help update and increase prescribing confidence in their primary care practitioners. This meant they didn’t have to refer individuals out to specialists and risk lapses in care.
We also have data to measure the impact of academic detailing. Upon completion of an academic detailing visit with Illinois ADVANCE, participants complete surveys on the likelihood of adopting a key message into practice before and after an academic detailing visit. In one evaluation of the effect of academic detailing on opioid prescribing, prescribers reported they were more likely to implement practice changes after an academic detailing visit. We found this is true in actual practice when reviewing PMP (prescription monitoring program) prescription data amongst clinicians who were detailed on safe opioid prescribing.
Are there particular communities or patient groups that you think benefit most from academic detailing?
Rural communities, areas with limited resources or access to care, and underserved populations can all benefit from a healthcare team armed with this kind of knowledge. It means fewer referrals out, a broader scope of care offerings, and practice changes that improve outcomes.
Importantly, academic detailing is a lasting relationship that continues to offer information and share resources. This means those who participate can receive resources such as where to obtain free naloxone, which home blood pressure devices are validated, patient-facing information on understanding pain, and public health resources. These are all tools to improve the information patients receive at an appointment so they can be stewards of their health in the time between appointments. Additionally, both the education and awareness of these resources can mean patients have more access to care with fewer gaps in care.
How important is the relationship-building aspect of your role when it comes to having influence with prescribers?
This is extremely important, especially since academic detailing is a discussion where learning goes both ways instead of a lecture. Academic detailers hold themselves to a high level of integrity. We provide unbiased, accurate, updated, evidence-based information and work hard to build trust and credibility. This means lots of curiosity, open-ended questions, and active listening. It also means being able to address objections.
On a larger scale, relationships with state and professional organizations are very important for an academic detailing program. It helps the program to be visible and credible to healthcare professionals throughout the target area of the population served (eg, throughout Illinois). This increases reach to the areas that benefit most. This is trust-building through transparency: being clear where the information we give comes from, being present within healthcare settings and organizations, and visible in the communities where we detail.
How can people help support and grow the academic detailing movement?
Participate! Healthcare professionals can identify an academic detailing program and complete a visit. This is the best way to really understand how this education can be utilized to its full potential. Encourage others to participate as well, so that your team can all start with the latest evidence-based information. From there, start implementing practice changes; sometimes there are even opportunities to adapt a workflow or create EMR (electronic medical record) order sets to make these changes more accessible and efficient. Use the model of academic detailing for communication with the interdisciplinary team and patients.
Improved patient outcomes because of the integration of academic detailing help make it more visible. This can result in more participation and growth of academic detailing programs and resources. There are also resources available to support the creation of new academic detailing programs and to train detailers.