The Pennsylvania Academic
Detailing Program
Pharmaceuticals Conference
Evidence Based Medicine and Counter Detailing
Thomas M. Snedden,
(tsnedden@state.pa.us)
Director,
Pennsylvania PACE Program
(www.aging.state.pa.us)
National State Attorney General Program
At Columbia Law School
New York, New York
May 11, 2007
The Pennsylvania
Academic Detailing Program
Academic detailing is a supplement
to PACE’s long-standing,
comprehensive, concurrent and
retrospective DUR processes.
Program expectations
The medication educator’s role
Our goals
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To provide evidence-based, noncommercial information about
medications to physicians
To facilitate physicians’ use of that
information in making the best
prescription choices (efficacy, safety,
and cost) for their patients
Program strengths:
Service, credibility, and integrity
Service
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Providing useful, practice-relevant information…
in a very time-efficient way…
that would be difficult to assemble oneself…
delivered in a professional, supportive manner.
Credibility
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Evidence-based materials, developed by experts
Non-commercial viewpoint
Integrity
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Only goal is to improve prescribing and patient care
No pharmaceutical company funding
Salary is not based on sales performance
Goal 1:
To provide physicians with current,
evidence-based, non-commercial drug
information
HOW?

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Offer the physician a flexible schedule for visits
Respond to questions knowledgeably, honestly, and with
the weight of the evidence—or find someone who can!

Offer free CME credits to add value to the interaction

Present a professional appearance and pleasant demeanor

Practice the art of persistence
Goal 2:
To facilitate physicians’ use of that
information in making the best prescription
choices (efficacy, safety, and cost) for patients
HOW?
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Identify the physician’s needs, priorities, and concerns
Offer tools and resources to facilitate better choices (data
summaries, patient education materials, etc.)
Refrain from excessive bashing of drug manufacturers
What makes a medication
educator unique?
Drug rep
Medication educator

Serves: drug company

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Product: drug

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Goal: maximize use of a
particular drug for profit$

Serves: doctor
Product: knowledge about
drugs
Goal: Share knowledge with
doctor that will result in
optimized prescription
choices
Pharmaceutical company
relationships

No affiliations with a pharmaceutical
company (paid or unpaid)

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
Consulting
Employment
Speakers bureau/seminars/conferences
Educational modules completed
(whom to treat, which drugs to choose)


Cox-2’s / NSAIDs
Gastric acid: PPIs, H


blockers
Nexium, Prilosec, etc.
Anti-platelet drugs

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2
Plavix, aspirin
Cholesterol-lowering drugs

Lipitor, Crestor, Zocor, other statins
Drug Consultants

Clinical background in nursing, pharmacy

10 individuals employed
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7.5 FTE total
Located in areas with highest density of PACE
beneficiaries
Multi-day training sessions in Boston
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6 nurses, 4 pharmacists
regular followup teleconferences for updates,
feedback
Quarterly one-on-one visits, ongoing
relationships with prescribers
The Harvard connection
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Systematic review of current medical
literature  evidence-based synthesis
Development of user-friendly materials
Follow-up, consultant support
Responses to MD questions
Fiscal management
Program evaluation
Web presence – www. RxFacts.org
Detailer activity through
mid-November
N
Completed educational encounters
974
Unique providers who have had
educational encounters
450
Educational encounters by topic*
iDiS introduction
175
coxibs/NSAIDs
362
PPIs, acid-suppressing therapy
340
anti-platelet therapy
240
statins, lipid-lowering therapy
2
Survey item:
Mean ± SD
1=Strongly disagree 2=Disagree 3=Neutral 4=Agree 5=Strongly Agree
The program provides me with useful information about
commonly used medications
4.6 ± .5
The content represents unbiased and balanced
information about drugs
4.6 ± .5
The program provides a perspective on prescribing that is
different form what I get from other sources
4.4 ± .6
My Drug Information Consultant is a well-informed source
of evidence-based information about drugs I prescribe
4.6 ± .5
I find the patient materials useful in my practice
4.3 ± .8
Being able to get Continuing Medical Education credits
from Harvard is a valuable component of the service
4.0 ± 1.2
It makes sense for the Commonwealth of Pennsylvania to
devote resources to this activity
4.5 ± .6
I would like to see this program continue
4.6 ± .6
The media have noticed
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Wall Street Journal
 Page One, March 13
“The Daily Show”
 May 4, www. TheDailyShow.com
The New York Times
 op-ed, September 16
Harvard Magazine, The Harvard Health Letter
 November
The Boston Globe
 February 26, 2007
The Central Pennsylvania Business Journal
 April 2007
Effect on drug utilization:
preliminary analysis
The cox-2 / NSAID module
IDIS intervention month
800
600
400
200
Internal control cohort
Intervention cohort
0
-18
-17
-16
-15
-14
-13
-12
-11
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
1
2
3
4
5
6
7
Coxib spending per physician
1000
Months before and after intervention month
Next steps


Additional analyses are ongoing
Additional drug topics to be covered:
–Hypertension
–Alzheimer’s disease
–Diabetes

Broaden to other state programs?
–state employees/retirees
Questions