VA Pharmacy Benefits Management Academic Detailing Service, San Diego, CA, USA; Division of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.
VA VISN 21 Sierra Pacific Network, Las Vegas, NV, USA.
Int J Med Inform. 2022 May;161:104712. doi: 10.1016/j.ijmedinf.2022.104712. Epub 2022 Feb 7.
Academic detailing, an educational outreach that promotes evidence-based practices to improve the quality of care for patients, has primarily been delivered using one-on-one in-person interactions. In 2018, the U.S. Department of Veterans Affairs (VA) Pharmacy Benefits Management implemented a pilot virtual academic detailing program to increase naloxone prescribing among veterans at risk for opioid overdose or death. The aim of this evaluation was to compare virtual and in-person academic detailing on naloxone prescribing rates at VA.
A retrospective quasi-experimental pretest-posttest non-equivalent groups design was used to compare virtual academic detailing and in-person academic detailing on naloxone prescribing rates 12 months before and after providers received a naloxone-specific encounter at three VA regional networks between January 1, 2018 to May 31, 2020. Subgroup analysis was performed on rural providers. Generalized estimating equation models were constructed to compare the difference in naloxone prescribing rates before and after receiving virtual or in-person academic detailing controlling for provider-level characteristics.
Providers who received virtual (N = 67) or in-person (N = 186) academic detailing had significant increases in naloxone prescribing, but the differences in the naloxone rates between the groups were not statistically significant (difference in changes in naloxone rates=+0.63; 95% CI: -2.23, 3.48). Similar findings were reported for rural providers.
Providers who received naloxone-related in-person or virtual academic detailing had increased naloxone prescribing rates; however, there were no differences between the two types of modalities. Virtual academic detailing is a viable alternative for delivering academic detailing and allows academic detailers to expand their reach to rural providers.
学术细化是一种教育推广活动，旨在通过促进基于证据的实践来提高患者护理质量，主要通过一对一的面对面互动来进行。2018 年，美国退伍军人事务部（VA）药房福利管理实施了一个虚拟学术细化计划试点，以增加有阿片类药物过量或死亡风险的退伍军人开纳洛酮的处方。本评估的目的是比较虚拟和面对面学术细化对 VA 纳洛酮处方率的影响。
采用回顾性准实验前后测试非等效组设计，比较 2018 年 1 月 1 日至 2020 年 5 月 31 日期间，三个 VA 区域网络中，提供者接受纳洛酮特定就诊后 12 个月内，虚拟学术细化和面对面学术细化对纳洛酮处方率的影响。对农村提供者进行了亚组分析。构建广义估计方程模型，比较接受虚拟或面对面学术细化前后纳洛酮处方率的差异，同时控制提供者层面的特征。
接受虚拟（N=67）或面对面（N=186）学术细化的提供者纳洛酮处方率显著增加，但两组之间纳洛酮率的差异无统计学意义（纳洛酮率变化差异=+0.63；95%CI：-2.23，3.48）。农村提供者也有类似的发现。
接受纳洛酮相关面对面或虚拟学术细化的提供者纳洛酮处方率增加；然而，两种模式之间没有差异。虚拟学术细化是提供学术细化的一种可行替代方案，并允许学术细化人员将其覆盖范围扩大到农村提供者。
