Effectiveness of Academic Detailing to Optimize Medication Prescribing Behaviour of Family Physicians

Abstract

PURPOSE. To synthesize current knowledge about the effectiveness and the magnitude of the effect, of Academic Detailing (AD), as a stand-alone intervention, at modifying drug prescription behavior of Family Physicians (FPs) in primary care settings. METHODS. A search of MEDLINE, EMBASE, CENTRAL, and Web of Science databases of all English language articles between January 1983 and July 2010 was conducted. We hand-searched the bibliographies of articles retrieved from the electronic search to identify additional studies. Inclusion criteria were: full-length articles describing original research; randomized controlled trial (RCT), or observational study design with a control group; studies of AD delivered to FPs; AD as a stand-alone intervention; drug prescription as the target behavior. Data extraction was done independently by two reviewers. Outcomes evaluated were: the difference in relative change in prescription rate between the intervention and control groups; the difference in absolute change in prescription rate between the intervention and control groups; and effect size, calculated as the standardized mean difference. RESULTS. 11 RCTs and 4 observational studies were included. Five RCTS described results showing effectiveness, while 2 RCTs reported a positive effect on some of the target drugs. Two observational studies found AD to be effective, while 2 did not. The median difference in relative change among the studies reviewed was 21% (interquartile range 43.75%) for RCTs, and 9% (interquartile range 8.5%) for observational studies. The median effect size among the studies reviewed was -0.09 (interquartile range 2.73). CONCLUSION. This systematic review demonstrates that AD can be effective at optimizing prescription of medications by FPs. Although variable, the magnitude of the effect is moderate in the majority of studies. This systematic review also provides evidence supportive of the use of AD as a strategy to promote evidence based prescription of medications or incorporation of clinical guidelines into clinical practice.

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

“…Twenty-eight reviews [20, 21, 29, 32–56] ( n  = 509 studies) evaluated educational interventions. Evidence from moderate- to high-quality reviews demonstrated that education to improve knowledge and skills [37–42, 48, 49, 51–56], continuing medical education [20, 21, 29, 34, 43], and academic detailing [32] were found to be effective in professional development to increase knowledge, optimize prescriptions, screening rate, and improve patient outcomes [20, 29, 32–36, 41, 44, 45, 50, 54].…”

“…Evidence from moderate- to high-quality reviews demonstrated that education to improve knowledge and skills [37–42, 48, 49, 51–56], continuing medical education [20, 21, 29, 34, 43], and academic detailing [32] were found to be effective in professional development to increase knowledge, optimize prescriptions, screening rate, and improve patient outcomes [20, 29, 32–36, 41, 44, 45, 50, 54]. Certain education interventions were evaluated as components of multifaceted education interventions, including interactive educational methods, reminder systems, audit and feedback, academic detailing, computer-based learning, lecture, as well as pamphlet in several reviews [29, 33, 36, 43, 44, 49]; which reported improvement in implementing guidelines into general practice [29], improved antibiotic prescribing [33], improved detection of cancer, dementia, and skin lesions [36, 44, 49].…”

Tracking Implementation Strategies in the Randomized Rollout of a Veterans Affairs National Opioid Risk Management Initiative

“…Academic detailing is, in and of itself, an evidence-based, multi-component implementation strategy that includes needs assessments, education, and focused training and has contributed to successful implementation efforts across a number of domains. 24,[28][29][30][31] In VA, academic detailing is typically conducted by clinical pharmacists, who deliver face-to-face, 1-on-1 training. Our ndings support the notion that academic detailing is effective as a preimplementation, or "preparation" strategy, as we found that academic detailing measured prior to implementation was associated with the outcome.…”

Tracking Implementation Strategies in the Randomized Rollout of a Veterans Affairs National Opioid Risk Management Initiative

“…Academic detailing is, in and of itself, an evidence-based, multi-component implementation strategy that includes needs assessments, education, and focused training and has contributed to successful implementation efforts across a number of domains. 21,24,25 In VA, academic detailing is typically conducted by clinical pharmacists, who deliver face-to-face, 1-on-1 training. Our findings support the notion that academic detailing may be most effective as a pre-implementation, or "preparation" strategy, as we found that academic detailing measured prior to implementation was associated with the outcome.…”