Academic detailing gathers momentum

Federal legislation is afoot to establish an academic detailing program. Drafted by Sen. Herb Kohl (D, Wis.) and Assistant Majority Leader Dick Durbin (R, Ill.), the goal is to counter current marketing practices in the drug industry by giving prescribers unbiased information on the comparative effectiveness of prescription drugs.

"We add balance to the toolkit that prescribers bring to daily practice," explained Michelle Spetman, co-director of the academic detailing program at Independent Drug Information Service (iDiS). "Academic detailing is free of commercial bias."

Spetman helps run academic detailing for PACE (Pharmaceutical Assistance Contract for the Elderly), which provides comprehensive pharmaceutical coverage for about 430,000 patients in Pennsylvania. The program is the brainchild of Jerry Avorn, M.D., professor of medicine at Harvard University. In the early 1980s, Avorn conducted studies showing that providing noncommercial drug information to prescribers can change prescribing habits. He found that every dollar spent on academic detailing reduces overall healthcare spending by about two dollars. Subsequent studies have found a similar return on investment in academic detailing, Spetman said.

"It's not just a question of cost," said Marcia Hams, assistant director of The Prescription Project, a public interest group in Boston that promotes evidence-based prescribing. "It is likely that 20,000 people died from Vioxx (rofecoxib, Merck). That is clearly inappropriate prescribing. Academic detailing is one way to derail the marketing juggernaut."

A draft version of the Kohl/Durbin bill would create two grant programs. The Agency for Healthcare Research and Quality would support the creation of independent educational materials for prescribers. Medical schools, academic medical centers, schools of pharmacy, and medical societies would be eligible for grants. The Centers for Medicare & Medicaid Services would send specially trained pharmacists and nurses to prescribers with large Medicare populations to present the information.

Both models are already in the field. IDiS is working with Harvard Medical School and other academic groups to research and create educational materials. IDiS and Pennsylvania present the noncommercial materials to prescribers, usually in one-on-one sessions with pharmacists and nurses. The group has contacted about 3,000 prescribers since October 2005, Spetman said.

At the other end of the spectrum is the Vermont academic detailing program, headed by pharmacist Amanda Kennedy and run through the University of Vermont College of Medicine. Her pharmacists and nurses see about half of Vermont's 350 primary care prescribers each year. "We don't tell prescribers what to do," Kennedy said, "we present information. It's a very pharmacist-friendly activity that is also a very effective means of changing prescribing patterns. We talk evidence and guidelines, not products."

Sarah Ball, program director for academic detailing and assistant professor of clinical pharmacy and outcomes sciences at the University of South Carolina College of Pharmacy, is taking a similar approach. She is rolling out SCORxE, or South Carolina Offering Prescribing Excellence. The $2 million program is being funded by the state Department of Health & Human Services. The two-year pilot is sending clinical pharmacists to physicians in counties with about half of the state's Medicaid population to talk treatment options in schizophrenia and major depressive disorders. If the SCORxE pilot is successful, it will go statewide.

"Academic detailing is a great approach to putting balanced information into prescribers' hands that is free from commercial influence," Ball said. "After 25 years of talking, action is finally rolling."