Partnering for Success

Through ACADEMIC DETAILING, UIC collaborates with the State of Illinois and health systems to improve opioid prescribing.

Enough was enough.

By 2017, the number of overdose deaths in Illinois involving opioids had reached an all-time high, approximately 2,200 fatalities in the state according to the National Institute on Drug Abuse. While heroin or synthetic opioids accounted for most of those fatalities, deaths related to prescription opioids had continued to climb steadily since 2012 and claimed some 550 lives in 2017 alone.

“An array of social, clinical, and economic forces conspired to create the opioid epidemic and it showed no signs of relenting,” says Dr. Simon Pickard, a professor in the college’s Department of Pharmacy Systems, Outcomes, and Policy (PSOP).

Illinois public health leaders, including administrators at the Illinois Prescription Monitoring Program (PMP) that collect information on Schedule II-V prescriptions written by licensed prescribers and dispensed by Illinois retail pharmacies, noted the disturbing trend, too. With an eye on implementing community and health system–level interventions as part of the state’s multifaceted approach to fight the opioid epidemic, PMP leaders reached out to Pickard and PSOP department head Dr. Todd Lee about implementing an educational outreach program.

“They had the knowledge, skill set, and expertise to help us,” PMP clinical director Dr. Sarah Pointer says of the UIC faculty tandem that had been collaborating with the state on preventative approaches to address the opioid epidemic since 2015.

It didn’t take Pickard and Lee long to present a compelling option: academic detailing, a novel method of educational outreach designed to arm providers with current evidencebased information through individual, face-to-face visits with specially trained personnel, namely pharmacists.

“We have the expertise and depth to do this kind of work, and that gave us confidence to suggest academic detailing,” Pickard says. “We know how to design research that generates quality insights, how to evaluate drug treatment patterns, understand how to interpret data, and have a good grasp on how to educate physicians with evidence.”

In the subsequent years, UIC’s innovative work with the Illinois PMP has morphed from a fruitful Centers for Disease Control–funded pilot program with one of the Chicago area’s largest healthcare systems into a current three-year grant expanding opioid-related academic detailing across Illinois and helping to curb prescription opioid abuse.

LAYING THE GROUNDWORK

Before the UIC team could roll out academic detailing and evaluate its impact on opioid prescribing activities, it first needed buy-in from a healthcare system. With an assist from PMP leadership, UIC teamed with AMITA Health, a Chicago-based enterprise that operates 19 hospitals across the Chicago metropolitan area.

With AMITA on board, Pickard and Lee developed the academic detailing program, which included training UIC pharmacy students like then-P2 student Victoria Kulbokas, PharmD ’20, to execute the one-on-one detailing visits. Thereafter, PSOP PhD student Dr. Mary Smart formulated outreach plans and prepared the educational materials for visits.

“This was a unique opportunity to get involved in research, interact with providers, and apply the knowledge I was gaining in my studies to a professional setting,” Kulbokas says of her involvement in the project.

Over a 14-week period in the summer of 2018, UIC-trained academic detailers visited 183 physicians across the AMITA Health Medical Group. In those initial 20-minute encounters, academic detailers discussed CDC guidelines for appropriate treatment of patients with chronic noncancer pain.

Introductory visits also included outlining available resources, such as treatment options for opioid use disorder as well as the Illinois prescription database that enables providers to evaluate their own prescribing patterns. In addition, detailers documented individual challenges related to safe and appropriate opioid prescribing practices, insights that helped them to tailor content during 158 follow-up visits.

“Physicians are always getting so much thrown at them, so it’s helpful to get the right information in the right format,” AMITA’s chief population health officer Dr. Reinhold Llerena (COM ’95) says. “In this case, UIC was a collaborative, willing, and patient partner that gave our physicians focused information practical to their day-today prescribing of opioids.”

EVALUATING IMPACT

Dr. Todd Lee

Aiming to understand academic detailing’s impact on opioid prescribing behavior, the UIC collective evaluated the impact on prescribing patterns among AMITA providers who participated in the program compared to a control group. Using PMP data, the researchers compared changes in opioid prescribing in the six months prior to the intervention against the six-month period following the intervention. Within the intervention group, opioid prescribing dropped nearly one prescription per provider per month following the academic detailing sessions.

“We demonstrated that this was feasible and, even more, could have a positive impact on high-dose opioid prescribing,” Pickard says. “It’s a surrogate indicator of what can likely save lives.”

Llerena credits the academic detailing with informing the work of AMITA’s physicians, heightening awareness about opioid prescribing and resources, and, most importantly, improving patient care.

“These visits have helped physicians at all levels become more in tune with what’s current in opioids, and having that access to effective resources and up-todate knowledge allows us to create better strategies to manage patients,” says Llerena, adding that 90 percent of physicians expressed satisfaction with their initial academic detailing visit.

Pickard calls the project a case study in the importance of bringing together stakeholders in healthcare—state government, universities, health systems—to achieve aims only possible through collaboration and teamwork.

“It also highlights how critical it is to have communityminded leadership in health systems like AMITA, where physicians like Dr. Llerena take action and get behind initiatives for the greater good,” Pickard notes.

Dr. Mary Smart

Beyond the clinical benefit, the project ignited another important outcome—and one in line with UIC’s academic mission. It granted College of Pharmacy students such as Kulbokas and Smart intimate exposure to research that impacts clinical practice. The project, in fact, propelled Kulbokas into PhD work in outcomes research at UIC, while providing Smart valuable experience in organizing an outreach endeavor supporting patients, providers, and healthcare systems.

“This is the UIC advantage,” Pickard says, adding that “several dozen students” have worked on opioid-related research projects since he and Lee began collaborating with the Illinois PMP in 2015.

Dr. Simon Pickard

EXPANDING THE EFFORT

Spurred by the results of its initial academic detailing project with AMITA, UIC and the PMP are now conducting a three-year, CDC-funded effort to expand and evaluate the academic detailing program at AMITA and additional Illinois-based healthcare systems. While continuing to assess the effect of academic detailing with prescribers, the current project extends the work to dispensers as well, aiming to help pharmacists across the state increase their queries to the PMP and become more informed practitioners with respect to opioids.

“There’s a definite disconnect that needs to be filled and UIC is coming in with this education to help produce more coordinated opioid prescriptions,” Pointer says.

To that point, the PMP reports an increase in queries since the academic detailing intervention began in 2018, a data point underscoring the work’s effectiveness.

“We have clearly seen the impact of the one-on-one relationship and academic detailing as a great resource and valuable way to reach providers,” Pointer says.

Dr. Victoria Kulbokas

Rooted in trust and ongoing relationships focused on education, not solicitation, “our goal is to provide education and promote evidence-based practices, not to dictate prescribing,” Smart reminds. The academic detailing visits stand as a promising intervention in the critical and ongoing battle against opioid abuse.

“There’s limited evidence into how long-term educational outreach programs like ours impact opioid prescriptions, but we’re seeing positive and encouraging results here,” Lee says. “Now, we just keep marching ahead with more outreach and more evaluation."

Academic detailing’s rising role at UIC

At the UIC College of Pharmacy, associate dean for professional and governmental affairs Mary Moody oversees a group of 30 pharmacists trained to conduct academic detailing visits. Illinois ADVANCE (Academic Detailing Visits and New Evidence Center) is the nation’s largest such program and one with a swelling reputation for delivering quality, evidence-based drug information to providers.

Prompted by a 2019 Illinois law that required the establishment of an evidence-based, noncommercial education program for the state’s Medicaid prescribers, Illinois ADVANCE provides unbiased, up-to-date drug information via one-on-one educational meetings with clinicians.

“We’re not promoting one specific therapy over another, but rather helping prescribers become more aware and informed when prescribing,” Moody says.

Academic detailing borrows its model from pharmaceutical manufacturers, whose one-on-one encounters with providers was shown to influence prescribing practices.

“The idea was, ‘Let’s use evidence-based literature to inform prescribing as well,’” says Moody of the academic detailing movement that began at Harvard University about 30 years ago and is now sharpened by the Boston-based National Resource Center for Academic Detailing.

Through brief, ongoing visits, academic detailers supply busy providers with accurate and current data about comparative effectiveness, safety, and other pertinent information and resources about specific prescriptions, diagnoses, and healthcare activities. Though still a relatively novel intervention, it is nevertheless one with a growing reputation for effectiveness.

“There’s more and more evidence regarding the value of academic detailing on prescribing,” reports Moody, whose team operates a toll-free drug information hotline and hosts continuing education programs for prescribers in addition to conducting the academic detailing visits.

While the center’s one-on-one visits have thus far centered around opioids—efforts connected to the work of professors Simon Pickard and Todd Lee—the center will soon add diabetes to its workload before rolling in other chronic diseases, such as hypertension and drugs for high lipids.

“The goal is to add a new disease every six months and see prescribers twice each year,” says Moody, who has been working with health system leadership, the Illinois Academy of Family Practice, and the Illinois Hospital Association to broaden the scope of Illinois ADVANCE’s work. “We want to continue to collaborate and show the value of academic detailing as an important and valuable service.”

Moody also touts academic detailing as a compelling opportunity for pharmacists to use their skills beyond traditional retail or clinical settings.

“This is a new role for pharmacists and an opportunity for them to grow and develop in their careers in a different way,” Moody says.