The practice of academic detailing is gaining interest and momentum in some health care circles. The primary aim of academic detailing is to prevent the overuse and misuse of certain medications. This is done by educating prescribers on the therapies that are clinically appropriate as well as the costs of therapeutically similar choices. It is less an issue of switching to generics than it is of favoring step therapy or moving toward cost-effective therapeutically equivalent options. A well-designed program should maintain prescriber autonomy and quality of care while helping manage drug costs for both health plans and patients.
How do such programs work?
Academic detailing programs typically have a field staff that not unlike detailers for pharmaceutical manufacturers, calls on physicians who are high-volume prescribers of medications whose costs are selected for management under the program. Academic detailers have backgrounds in nursing, pharmacy, and pharmacology. Some programs have used physicians as detailers,1-3 but that increases the cost of such programs.
One of the most comprehensive programs is the Independent Drug Information Service (iDiS) in Pennsylvania, in which trained persons meet with physicians throughout the state. The program's goal is "to improve appropriateness of prescribing by providing unbiased, noncommercial, evidence-based, and timely information to prescribers."4
The program is administered by the Pennsylvania Office of Health Care Reform. Clinical direction is provided by consultants at Harvard Medical School in Boston,4 who have trained a team of clinicians in Pennsylvania on academic detailing, drug classes selected and rationale, and the message to communicate to prescribers.
The Pennsylvania initiative grew out of a desire to implement sound policies for coverage of prescription drugs across all of the state's programs.4 The iDiS replaced a point-of-sale prospective audit that rejected claims for certain medications not on the state's preferred list.
How are targeted drugs selected?
A comment made frequently by program leaders is that academic detailing is not about not prescribing a particular drug because of cost. Instead, they say, it is about targeting certain categories of drugs that have the potential for overutilization or inappropriate use, drugs for which it was felt the physicians needed to have medical evidence regarding when and when not to prescribe.
The Pennsylvania program targets prescribing practices in 6 therapeutic classes, including cyclooxygenase-2 and proton pump inhibitors.
