Roar Dyrkorn Head of Project Academic Detailing

Spec. in Clinical Pharmacology and Family Medicine

Dept. for Clinical Pharmacology

St. Olavs Hospital, Trondheim , Norway

Roar.Dyrkorn@stolav.no

Representing:

THE CHALLENGE !

GPs are drowning in therapeutic guidelines !

With permission: Bjarne Alstad

Clinical

Guidelines:

ca. 100 pages

Addictive

drugs

Clinical

Guidelines:

ca. 6

20-40 pages

each

Rheumatology

Clinical

Guidelines:

30 pages

Obestias

Clinical Guidelines in our National Health Library www.helsebilblioteket.no

and others who want to have influence on medical practice

Psychiatry

Clinical

Guidelines:

16

20-150 pages

Expert groups

and «task

forces»

Patient

organizations

Industrial

sponsors

Diabetes

Clinical

Guidelines:

124 pages

Expert groups

and

«taskforces»

Patient

organizations

Industrial

sponsors

Hypertension

Clinical

Guidelines:

«numerous»

Expert groups

and «task

forces»

Patient

organizations

Industrial

sponsors

Muscle- and

Skeletal

disorders

Clinical

Guidelines:

ca. 20

20-100 pages

Expert groups

and «task forces»

Patient

organizations

Industrial

sponsors

Osteoporosis COPD and

Pulmonary

Clinical

Guidelines:

12

20-190 pages

Expert groups

and «task

forces»

Patient

organizations

Industrial

sponsors

Cardio-

vascular

Clinical

Guidelines:

6

18-400 pages

Expert groups

and «task

forces»

Patient

organizations

Industrial

sponsors

IMPOSSIBLE FOR GPs TO BE UPDATED ON ALL THIS TO ALL TIMES !

And of course; Dear Health Care Provider Letters

Academic Detailing in Norway is called: evidencebased uppdating visits

Since 2006 we have been offering GPs different types of

pharmacological education/training.

Academic detailing started in 2015

Academic Detailing is a one-to-one interactive communication with a

practicing doctor which lasts about 20 minutes during office hours

discussing a therapeutic guideline or f.ex. “Better use of NSAIDs”

Our opinion is that this method is very well suited for personalized

support for good clinical decision-making.

Avd. for klinisk farmakologi

It was Avorn and Soumerai who first introduced the method

Academic Detailing through an article in NEJM in 1983

Their idea was no rocket science, but they showed that it

worked

”Think if we could use the communication - and

marketing skills of the pharmaceutical industry to present

independent and evidence based knowlegde to practicing

doctors in their own practices”

AUSTRALIA, since 1999

Independent Not-for-Profit Evidence Based

Our programs are funded by the Australian Government,

Department of Health and our members

Educational Visiting Service Delivery in Australia

•1991 DATIS commenced in Adelaide, South Australia

• 1999 NPS national programme

• greater than 70% of GPs in Australia have participated

•Approaching 250,000 visits conducted Australia wide

•Approx 25,000 health professionals participate each year

•Three programmes offered per year

Academic Detailing in Norway

• Since 2012 we have been studying the method Academic Detailing at:

• The Drug and Theraputic Information Service, DATIS, in Adelaide

• The National Prescribing Service, NPS, in Sydney

• The National Resource Center for Academic Detailing, NaRCAD in Boston

• I visited Debra Rowett and the National Prescribing Service for 6 weeks and

attended their seminars and visits to local GPs

• We also attended seminars and workshops at The National Resource Center for

Academic Detailing, NaRCAD, in Boston, USA

• Academic Detailing is also used in Canada, Brasil and India

• And in Norway we gradually worked towards our health authorities to introduce the

method Academic Detailing in Norway

• In January 2015 we got funding to start our first campaign and Debra Rowett came

to Norway to educate 20 clinical facilitators

Which goals do we have?

• We want to use AD to:

Maintain and eventually increase GPs phamacological

competence to avoid harm amongst their patients

Background

NSAIDs are one of the most widely used classes of drugs worldwide

and are used to treat common conditions such as pain, fever and

headaches.

For years, regulators have known about increased risk for heart

attack and stroke from NSAIDS, especially when taken in high

doses for prolonged periods.

Then in 2004 and 2005, two high-profile drugs, Merck's Vioxx and

Pfizer's Bextra, respectively, were pulled from the market due to

increased risk for heart attack and stroke.

Dear Health Care Provider Letters:

Improving Communication of Important Safety

Information; do not seem to have the Desired Impact???

Interpretation The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to

coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although

NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which

could help guide clinical decision making.

Funding UK Medical Research Council and British Heart Foundation.

Serious cardiovascular events Serious coronary events Serious G/I – adverse events

«Better use of NSAIDs» was our first campaign

We visitied 213 of 247 GPs in the cities of Trondheim and Tromsoe

during February, March and April 2015 and 169 answered a Questback

after the visit

98 % answered that they got useful information about NSAIDs

99 % answered that the topic was relevant for their practice

92 % said that they would to a great or a certain extent change their

practice when prescribing NSAIDs

90 % considered Academic Detailing as a very suitable method for

producer independent and evidence based information

98 % said that they would be happy to receive a new visit on another

topic

Avd. for klinisk farmakologi

Collecting data

We used The Prescription Database to collect data on

NSAIDs prescriptions from one year before our campaign

and are going to collect data monthly for one year after

our campaign

This gives us the opportunity to see if changes in

prescriptions are persisting

Avd. for klinisk farmakologi

Results from The Prescription Database

Changes

Diklofenak (inkl. kombinasjoner)

April - June 2014 * April - June 2015 * Change in %

Tromsø 7,2 5,8 -19,0 %

Bodø 10,1 9,5 -5,8 %

Trondheim 8,8 5,7 -35,1 %

Bergen 9,8 9,1 -6,6 %

Norway 9,5 8,9 -6,9 %

* Average prevalence, per 1000, per month

Better use of antibiotics We have visited 455 GPs; Response rate evaluation 73,9 %

96 % ment that 20 minutes were adequate

94 % answered that they got useful information about antibiotics

100 % ment the topic was relevant

67 % said that they would to a great or a certain extent change their

practice when prescribing antibiotics

99 % ment that right choice of antibiotic could reduce bacterial

resistance

97 % considered Academic Detailing as a very suitable method for

producer independent and evidence based information

98,5 % said that they would be happy to receive a new visit on another

topic

Ongoing campaign:

Academic Detailing

The method AD is based on trust and reliable relationships in

one-to-one interactive communication!

As Clinical Facilitators we have to believe that doctors allways

want to do the best for their patients

And the doctors we visit must allways be confident that the

message we deliver is evidence based and producer

independent for the best for their patients

Academic Detailing

Our opinion is that this method is very well suited for risk

communication in the field of medicine

This is how they do it in Australia:

https://www.youtube.com/watch?v=YDxQy-UTZEU

Avd. for klinisk farmakologi