Academic detailing as a quality improvement tool: Translating drug safety, efficacy, and cost-effectiveness evidence into medical practice

Physicians and patients need unbiased, evidence-based information about the comparative effectiveness, safety, and costs of prescription drugs. This information can be time-consuming to assemble from the research literature, which becomes more problematic due to time constraints, administrative burdens, patient demands, and the pace of innovation in medical practice.

Pharmaceutical companies are highly effective at communicating with clinicians, and their efforts often focus on high-profit drugs, pushing utilization toward expensive products. Public health budgets and outcomes are affected when clinicians prescribe new products with insufficient safety data, leading to excessive spend without resultant health improvements. Continuing medical education is designed to keep physicians abreast of therapeutic innovations; unfortunately, CME opportunities often use ineffective techniques or are commercially-funded.

For nearly 30 years, a team of Harvard Medical School physician-researchers have been developing ways to use the effective outreach strategies of pharmaceutical companies to communicate unbiased, evidence-based information about the safety, efficacy, and cost-effectiveness of therapeutic options. The approach is called “academic detailing” to reflect this hybrid concept. Academic detailing is utilized in many countries, and has been shown repeatedly to be a cost-effective method to promote safe, appropriate patient care.

The Independent Drug Information Service is an academic detailing program managed by the Harvard team, who comprehensively evaluate medical literature to assemble the best available information about therapeutics and synthesize it into concise, clinically-relevant materials for prescribers and patients, which are presented by a team of specially-trained clinicians. During these visits, academic detailers discuss therapeutic topics of interest to prescribers, employing techniques gleaned from study of effective interpersonal communication, adult learning, and social marketing. More than 3,000 educational visits have been completed, 450 CME post-tests completed, and 200 physician questions responded to. Anonymous evaluation responses show that the program is immensely popular among physicians. All materials are available at www.RxFacts.org.

Academic detailing is an appealing quality improvement resource because it provides a convenient source of accurate, evidence-based information for prescribers, helpful patient materials, and key messages that are independent of financial biases. Due to rising drug expenditures in both public and private settings, and increasing desire on the part of doctors and patients for evidence-based information about medication risks, benefits, and costs, academic detailing as a quality improvement tool makes sense, from both an economic and public health perspective. Academic detailing helps patients obtain safer, more affordable drug therapy, reduces soaring drug expenditures, and helps physicians provide high quality medical care.