TY - JOUR
AU - Bounthavong, Mark
AB - Abstract Purpose To provide a summary of the implementation of a virtual academic detailing pilot program at the US Department of Veterans Affairs (VA). Summary In September 2018, VA Pharmacy Benefits Management implemented a virtual academic detailing (“e-Detailing”) pilot program across 3 regional networks. Academic detailing involves multifaceted collaborative outreach delivered by trained healthcare clinicians to other clinicians using targeted educational interventions that improve clinical decision-making. Across VA, academic detailing programs are primarily staffed by specially trained clinical pharmacist specialists. Implementation began with an in-person meeting to train academic detailers on using the virtual academic detailing platform (VA Video Connect) and virtual soft skills, which was followed by regular facilitation meetings to address issues and share experiences. During e-Detailing program implementation, coronavirus disease 2019 (COVID-19) emerged, prompting the US Department of Health and Human Services to declare a public health emergency. VA followed with restrictions on nonessential travel for all employees, thus hampering in-person academic detailing activities. Fortunately, e-Detailing provided an alternative channel for academic detailers across VA to continue delivering critical outreach to providers during the pandemic. Qualitative assessment of academic detailers’ and providers’ perceptions on e-Detailing highlighted the need for local leadership support for e-Detailing and telehealth, the efficiency of virtual compared to in-person visits, and potential time savings resulting from avoidance of long commutes. Conclusion The timing of e-Detailing implementation during the COVID-19 pandemic illustrates the need and potential for a virtual platform to deliver timely provider outreach. implementation, program evaluation, telehealth, veterans, virtual academic detailing Key Points The US Department of Veteran Affairs (VA) implemented a virtual academic detailing pilot program at 3 regional networks; the e-Detailing program used existing telehealth infrastructure to increase reach and deliver critical outreach to providers. The COVID-19 pandemic highlighted the need and utility of e-Detailing when nonessential travel restrictions prevented academic detailers from performing traditional in-person outreach. Since implementation, e-Detailing has expanded to other regional networks beyond the initial pilot programs and has proven to be an important part of the academic detailing program at VA. The US Department of Veterans Affairs (VA), the nation’s largest healthcare system, was an early adopter of telehealth services to improve healthcare access for veterans. The passing of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in 2018 created several viable telehealth technologies and encouraged their widespread adoption by both healthcare providers and patients.1,2 VA Video Connect (VVC) was the first video-based conferencing software platform that allowed providers to connect with veterans outside of VA facilities, in locations such as their residences.3 However, rapid adoption of VVC was hindered by infrastructure (eg, poor signal, network problems, user error) and administrative barriers (eg, challenges in scheduling, coding, and training).4 These challenges were part of the impetus for the VA Pharmacy Benefits Management (PBM) Academic Detailing Service to implement a virtual academic detailing program (e-Detailing) at VA.5 Academic detailing involves multifaceted collaborative outreach delivered by trained healthcare clinicians to other clinicians using targeted educational interventions that improve clinical decision-making.5-8 It involves use of a social marketing framework to develop collaborative relationships with providers to deliver specific practice-change recommendations aligned with current evidence-based practice.9,10 Academic detailing has been reported to improve naloxone distribution for veterans at risk for opioid overdose and mortality,11,12 reduce unnecessary high-dose opioid13 and concomitant opioid and benzodiazepine prescribing,14 and increase medication use for alcohol use disorder.15 At VA, academic detailing is built on the foundations of in-person, one-to-one interactions using trained clinical pharmacist specialists as academic detailers16,17; however, significant challenges to implementation reach, particularly in rural communities where almost a quarter of all veterans in the United States reside, justified alternative means of interactions such as e-Detailing.18 The core principles of academic detailing were adapted for a virtual platform where academic detailers have the potential to increase their penetration into rural communities and improve access to time-sensitive outreach. A virtual academic detailing model implemented in partnership with telehealth champions was shown to be effective in disseminating critical training and improving the uptake of virtual visits.19 Recent telehealth policy changes in response to the historic coronavirus disease 2019 (COVID-19) pandemic have ushered in an unprecedented expansion of virtual services.20,21 The implementation of VVC in 2018 was critical for the rapid adoption of pandemic-driven virtual care delivery across the Veterans Health Administration (VHA). Moreover, on March 2020, VA suspended work-related and nonessential travel for employees, rendering in-person, one-to-one interactions between academic detailers and providers impossible (internal communication from Office of the Chief Human Capital Officer, March 6, 2020). Fortunately, e-Detailing efforts were underway prior to the pandemic, which allowed academic detailers to continue their activities despite a nationwide order barring nonessential travel. The VA e-Detailing program leveraged existing telehealth technology to increase implementation reach and quickly pivoted to use the same technology to maintain activities while delivering time-sensitive information to providers when the pandemic occurred.5 Even in the absence of a public health crisis, utilizing an e-Detailing model can ensure success when facilitating urgent or systemwide initiatives that require significant behavior change. Previous studies have reported high satisfaction and acceptability of virtual academic detailing,19,22 but it is unclear if this delivery mechanism can yield similar results as an in-person academic detailing interaction, fueling the need to understand the mechanisms of virtual academic detailing on delivering timely, urgent, or systemwide initiatives. Thus, it was essential that we investigate and understand the e-Detailing implementation process and the impact COVID-19 had on its progress. The objectives of this report are to provide an account of the VA e-Detailing pilot program’s implementation process and the impact of the pandemic on its mission to expand its reach to rural providers at 3 VA regional networks. Goals of the virtual academic detailing pilot The goals of the VA e-Detailing program were to (1) increase the reach of academic detailing, particularly to rural providers, and (2) engage with providers to adopt VVC as a communication modality for virtual care delivery to patients. It was critical that the VA e-Detailing pilot objectives include education of and familiarization with the VVC platform. This objective aligned with a larger VA directive instructing providers to become familiar with and engage in virtual or telehealth care with patients.23 Additionally, the VA e-Detailing program included clinical campaigns on opioid overdose education and naloxone distribution (OEND), pain management, and medication for opioid use disorder (OUD). However, with the advent of the COVID-19 pandemic, the e-Detailing pilot program shifted its focus to reaching all providers who were unable to participate in conventional in-person academic detailing. This evaluation was reviewed by the institutional review board at the VA San Diego Healthcare System (HRD210088) and granted exempt status as a quality assurance project. Innovation In September 2018, the VA PBM Academic Detailing Service, the national academic detailing program office for VA, implemented the e-Detailing pilot program to increase its reach among providers and staff at 3 VA Integrated Service Networks (VISNs 19, 20, and 21), which is comprised of VA facilities in Northern California, parts of Nevada, Alaska, Colorado, Idaho, Hawaii, Montana, Oregon, Utah, Washington, Wyoming, the Philippines, and US territories in the Pacific Basin. The e-Detailing pilot supported 3 full-time academic detailing positions to provide expanded transformational access using 2-way video telecommunications. The primary mode of communication used by the e-Detailing pilot program was the VVC platform, which provided a convenient mechanism to interact with providers without the need to log into the VA intranet. VVC can be securely accessed by a personal computer, tablet, or smartphone, making it a convenient mode of communication. Once an appointment is scheduled, the VVC platform will send an email to each participant with a unique web link. The academic detailer and provider will click on the web link on their scheduled appointment which will place them in a virtual medical room where they can have their academic detailing session (Figure 1). This well-timed dress rehearsal for the COVID-19 pandemic led to the effective delivery of educational outreach using the VVC platform. Figure 1. Open in new tabDownload slide VA Video Connect (VVC) platform. With VVC, a scheduler creates an appointment between the patient and provider. An email with a secure web link for a virtual medical room is sent. Additional resources for patients are also provided in the email to prepare them for their virtual visit. The patient and provider can click on the web link on the day of their virtual appointment, which will initiate their clinical visit. Only invited participants are allowed into the virtual medical room, but the provider may also lock the room to prevent other participants from entering. VVC can be accessed via personal computer and smartphones, and it provides a secure connection to ensure privacy and confidentiality. Figure 1. Open in new tabDownload slide VA Video Connect (VVC) platform. With VVC, a scheduler creates an appointment between the patient and provider. An email with a secure web link for a virtual medical room is sent. Additional resources for patients are also provided in the email to prepare them for their virtual visit. The patient and provider can click on the web link on the day of their virtual appointment, which will initiate their clinical visit. Only invited participants are allowed into the virtual medical room, but the provider may also lock the room to prevent other participants from entering. VVC can be accessed via personal computer and smartphones, and it provides a secure connection to ensure privacy and confidentiality. On January 27, 2020, the secretary of the US Department of Health and Human Services (HHS) declared COVID-19 a public health emergency.24 Once the pandemic began, the ability of healthcare professionals to communicate with their patients and each other was threatened. VVC provided a means for academic detailing to extend their reach, especially during the pandemic when social isolation prevented in-person interactions. By integrating clinical messaging with operational transformation, academic detailers were able to prepare staff for challenges that emerged during the COVID-19 pandemic. Participants of the e-Detailing pilot shared their successes and struggles with one another as well as with other academic detailing programs across VA through facilitation calls coordinated by the national academic detailing program office (see “Facilitation” section). Additionally, with support and direction from the national academic detailing program office, 3 VA networks involved in the e-Detailing pilot program began to promote adoption of e-Detailing by other regional networks. Academic detailers were split into teams, and awards were offered to the teams and individual academic detailers with the highest numbers of virtual visits during a 3-month period. Teams were created to provide support, encouragement, and education. This competition was successful in generating interest in e-Detailing by regional networks not involved in the pilot program, which demonstrated a commitment to evolving care to include virtual modalities. Their collaboration led to well-prepared clinicians and staff as the VVC platform was adopted across the nation and expanded healthcare access to patients despite limitations due to the COVID-19 pandemic. Implementation/training Implementation of e-Detailing began in September 2018 (see eSupplement A). Three VA regional networks were chosen due to geography that made it difficult to offer traditional in-person academic detailing to providers in rural, urban with heavy traffic, or trans-Pacific regions. Some VISNs, such as VISN 21, were fully staffed prior to the pilot, with one academic detailer assigned per site. The implementation of e-detailing allowed the region’s academic detailers to connect with providers at any of the regional medical centers, translating to greater provider outreach and fewer gaps in coverage during extended leave or vacancies. Participants from the VISNs 19, 20, and 21 attended an in-person advanced skills training for e-Detailing where academic detailers learned technical skills for conducting visits via VVC and soft skills surrounding virtual communication. Academic detailers were introduced to video modalities, including VVC, and they attended practice sessions where they used VVC to do an outreach visit with a volunteer provider at their VA facility. These new learning experiences included initiating and completing VVC visits at a workstation as well as booking and sharing VVC meeting invitations. Soft skills included guidance on personal appearance, effective on-camera communication, and motivation of providers to utilize the new platform. In-person training allowed academic detailers to experience technical issues associated with VVC, such as network bandwidth limitation, installation and setup, and general audio/video issues. Of note, network bandwidth issues improved over time as VA began nationwide adoption of VVC, especially during the COVID-19 pandemic, when the Coronavirus Aid, Relief, and Economic Security Act provided over $2 billion in supplemental funding to VA’s Office of Information and Technology to improve videoconference technology and network infrastructure.25 A facility telehealth coordinator was present at the in-person training to help troubleshoot technological issues during practice sessions. This was a critical part of the in-person training because it allowed academic detailers to interact with a telehealth expert and gain experience in troubleshooting technical issues. Additionally, motivational interviewing (MI) training was provided by a master trainer. The MI framework was reviewed, fundamental skills to improve engagement and diffuse discord were discussed, and an activity wherein detailers worked on identifying and diffusing discord during a provider encounter was performed. After training, academic detailers had 2 options for incorporating VVC into their daily academic detailing appointments. They could discuss VVC as an OEND campaign topic, assisting providers in acquiring the skills necessary to utilize VVC for direct patient care. A second option was to use VVC to conduct a live academic detailing visit with a provider. The OEND campaign was well suited for VVC visits, allowing providers to see how and when to use naloxone. Outreach was prioritized using dashboards that identified providers who had not yet performed virtual visits with patients. Academic detailers encountered various barriers and challenges during the initial implementation of e-Detailing. Barriers included widespread lack of equipment to support video communication (eg, headsets and cameras); limited network bandwidth in certain areas, particularly rural areas of high need, did not reliably support video communication. Additionally, difficulties obtaining provider engagement and commitment to conduct a virtual appointment were challenges that were identified during the implementation facilitation meetings. Over the course of the pilot program, more equipment was purchased and distributed (sometimes distributed by detailers themselves) and the network bandwidth challenge was resolved by the VA Office of Information and Technology. To address challenges regarding provider engagement, academic detailers relied on relationships with others at the provider’s facility to facilitate an introduction, provide practical meeting times, or offer information to build a platform for connection. Other strategies to overcome provider hesitancy surrounding initial engagement were socialization of the virtual academic detailing team, newsletters, warm handoffs from local academic detailers, and existing medical center educational events. Facilitation Implementation facilitation is a multifaceted process that enables and supports individuals, groups, and system stakeholders to adopt and sustain evidence-based practices and programs.26 With e-Detailing, the PBM Academic Detailing Service provided regular implementation facilitation for the regional networks through virtual meetings. Participants in the e-Detailing pilot program were invited to a virtual monthly facilitation meeting where information was provided to update academic detailers on video modalities, tips and tricks were developed to help them improve their skills, and best practices were shared to assist with implementation. Moreover, conflict and technical resolutions were discussed alongside experiences of other academic detailers’ success stories and lessons learned. Eventually, this monthly call expanded to all VA regional networks outside the initial pilot programs. Additionally, the 3 main e-Detailers from the pilot programs had weekly facilitation meetings with the PBM Academic Detailing Service to support their efforts on implementing e-Detailing, establish best practices, and troubleshoot issues encountered in early implementation. Similar to the monthly facilitation calls, the weekly facilitation meetings with the pilot programs provided more time and opportunity for the academic detailers to discuss strategies for barrier resolutions, develop guides and marketing materials, and engage in encouragement, audit and feedback, and role modeling. These weekly facilitation meetings resulted in 2 training videos to assist other academic detailers with e-Detailing. Program evaluation Since implementing e-Detailing at VA, a total of 2,346 visits were documented (Figure 2) between October 2017 and September 2020 (fiscal years at VA begin on October 1 of the previous year. For example, fiscal year 2018 began on October 1, 2017 and ended on September 30, 2018). Monthly trends of e-Detailing visits varied. A large number of e-Detailing visits were documented between May and June 2019 after the additional hire of academic detailers dedicated to performing e-Detailing. Specifically, this large spike in the number of e-Detailing visits in May to June 2019 was attributed to a particular e-Detailer who primarily focused on e-Detailing in the first quarter after being hired and trained. This was followed by a gradual increase in e-Detailing visits after the HHS announcement of a public health emergency due to the COVID-19 pandemic between January and September 2020. By August 2020, more than 50% of academic detailing visits were virtual. Between fiscal years 2018 and 2020, the monthly median number of e-Detailing visits documented significantly increased from 71.5 (IQR, 28.75) visits prior to the pandemic to 119.5 (IQR, 46.75) visits after the pandemic (P = 0.018). Figure 2. Open in new tabDownload slide Number of academic detailing visits using video technology at the 3 pilot regional networks in fiscal years 2018 through 2020. Figure 2. Open in new tabDownload slide Number of academic detailing visits using video technology at the 3 pilot regional networks in fiscal years 2018 through 2020. From fiscal year 2018 through fiscal year 2020, the top 4 e-Detailing campaigns were “Healthcare Modernization” (monthly average of 37.3 visits), “OEND — Opioid Overdose Education and Naloxone Education” (monthly average of 29.6 visits), “OUD — Opioid Use Disorder” (monthly average of 10.5 visits), and “Pain — Chronic” (monthly average of 11.9 visits). Figure 3 illustrates the monthly trends for the top 4 e-Detailing campaigns between fiscal years 2018 and 2020. There was a large spike of visits for the “Health Modernization” and OEND-focused campaigns between May and July in 2019. Another spike in “Healthcare Modernization” visits occurred in March 2020 after the HHS public health emergency was announced. These spikes were likely due to the activities of academic detailers who were hired and trained at the pilot sites. For instance, during the third quarter of fiscal year 2019, VISN 19 documented a large number of e-Detailing visits due to a local “mini-challenge” among the academic detailers. Figure 3. Open in new tabDownload slide Number of e-Detailing visits by the top 4 campaigns at the 3 pilot regional networks in fiscal years 2018 through 2020. Figure 3. Open in new tabDownload slide Number of e-Detailing visits by the top 4 campaigns at the 3 pilot regional networks in fiscal years 2018 through 2020. A total of 383 rural providers received e-Detailing by the end of fiscal year 2020 (Figure 4). The monthly cumulative number of providers increased sharply during the months of May to July in 2019, which aligns with the increased visits reported for the “Healthcare Modernization” and OEND-focused campaigns. Additionally, the number of rural providers receiving e-Detailing continued to increase throughout 2020, likely due to the COVID-19 pandemic. Figure 4. Open in new tabDownload slide Cumulative number of unique rural providers who received e-Detailing at the 3 pilot regional networks in fiscal years 2018 through 2020. Figure 4. Open in new tabDownload slide Cumulative number of unique rural providers who received e-Detailing at the 3 pilot regional networks in fiscal years 2018 through 2020. Qualitative component To supplement the quantitative evaluation of the e-Detailing pilot program, a team of experts in academic detailing and implementation conducted a qualitative process evaluation at 2 of the pilot networks in the western US in 2019 and early 2020. Using the Consolidated Framework of Implementation Research,27 the team developed a semistructured interview guide for academic detailers providing e-Detailing (see Supplement B), as well as a similar guide for providers who had received e-Detailing. The primary partner (PBM) provided the team a list of academic detailers who provided e-Detailing and a list of providers who had received e-Detailing from the aforementioned. Providers who had multiple sessions of e-Detailing were prioritized for recruitment. Across a 1-month period, 6 academic detailers were recruited and interviewed. Recruiting providers (n = 5) was challenging, and the recruitment window lasted more than 3 months. A key barrier to recruitment of providers was that they did not realize they had received e-Detailing because the interaction was brief and/or centered on using technology appropriately rather than topics typically covered in an academic detailing session. To facilitate actionable feedback, the team conducted a rapid analysis, a method the team has used previously.28 Findings from interviews with academic detailers highlighted technological challenges, as well as unanticipated opportunities that e-Detailing presents. Oftentimes, detailers were relied upon for technical assistance (eg, fixing a microphone, obtaining video equipment) rather than their expertise in improving safe and effective medication prescribing. This finding highlights the need to have technical personnel working alongside detailers so the latter individuals can focus on the intervention of interest (eg, naloxone prescribing). Academic detailers also noted that while e-Detailing has the potential to reach providers in rural and remote settings, it can be difficult to set up the initial appointment without a preexisting relationship with the provider. They maintained that an initial in-person visit to the rural/remote clinic may be needed. For example, one academic detailer noted, “I believe [e-Detailing] is an effective strategy for meeting with people for whom you might have an existing relationship.” A key takeaway from academic detailers’ interviews is the need for local leadership to support e-Detailing, including assistance surrounding technological challenges and encouragement of providers to meet with academic detailers through protected time, support around scheduling appointments, or requiring meetings between providers and academic detailers. Academic detailers also noted that e-Detailing may be better suited for discrete interventions, such as naloxone prescribing. In contrast, assisting a provider with long-term efforts, such as medication for those living with opioid use disorder, usually takes multiple sessions and may be difficult to accomplish effectively in an e-Detailing format. From an organizational standpoint, academic detailers noted e-Detailing was probably more efficient than traditional detailing, mainly due to time saved from avoiding long commutes. An academic detailer commented, “[E-detailing] has saved me so much time because . . . in the past I would drive an hour, an hour a half to a facility only to meet with a provider for like 15 or 20 minutes. And I think this saves a lot of time and it’s more efficient.” Similarly, providers described e-Detailing as more efficient. A provider noted, . . . [W]henever [detailing is] virtual, you’re not shaking hands and exchanging the niceties . . . . It’s more like quick Facetime, quick call, show you this, this, this, . . . I feel like it might actually save some time . . . . So actually, it might save—it might be more efficient to do this kind of stuff over the video connect.” Although findings were limited, there are some noteworthy lessons that can be assessed further in a future evaluation. In contrast with the academic detailers, most providers included in this evaluation noted they did not struggle with technology. This finding may indicate that detailers were successful in assisting with technology or may represent sampling bias resulting from recruitment challenges. Providers were divided in their perception of leadership support at their site, with 60% receiving support. While 40% of providers still valued the in-person visits, all providers noted that e-Detailing can be just as useful as in-person detailing, particularly if video technology is used. For example, one provider noted, “I think [e-Detailing] is just as effective over the video . . . for me; I want to see the PowerPoint that shows the actual [electronic medical record] notes of what I’m pulling.” This is aligned with a previous study wherein providers reported being satisfied with virtual academic detailing on appropriate opioid prescribing and pain management.22 COVID-19 impact The COVID-19 pandemic had an undeniable impact on the e-Detailing pilot program. This impact presented new barriers, resolved some existing barriers, and enabled academic detailers to capitalize on the expanding role of virtual communication. The advent of COVID-19 required VA to reprioritize its organizational focus; hence, the PBM Academic Detailing Service began preparations to shift resources from traditional academic detailing topics. This shift introduced barriers that reduced the effectiveness of academic detailers to deliver academic detailing on every mission-critical topic. It is unclear what impact this may have on other areas of healthcare at VA. However, the COVID-19 pandemic had some unexpected benefits for academic detailing. Establishment of relationships virtually, in the absence of a preexisting face-to-face relationship, was enhanced during the COVID-19 pandemic. Previously, the academic detailer had the ability to provide in-person academic detailing to establish new relationships. This became difficult or impossible due to travel restrictions and general limitations on face-to-face interactions. Once the COVID-19 pandemic began, virtual interactions became necessary, thereby increasing adoption of the VVC platform and e-Detailing. Moreover, prior to the COVID-19 pandemic, providing telehealth care was encouraged but not a widespread aspect of standard care.23 Care provided via telehealth expanded across the VA system during the COVID-19 pandemic. By mid-November 2020, VA had recorded an increase of 1,653% in telehealth visits since the end of February 2020.29 The initial success of the e-Detailing pilot program provided a roadmap that the rest of the academic detailing community could follow. Academic detailers who were not previously involved in e-Detailing were able to pivot their practice with virtual support and resources; e-Detailing visits related to assisting providers with VVC to interact with their patients spiked nationwide after the announcement of the public health emergency on January 27, 2020. As a result of these opportunities, providers and academic detailers have obtained an enormous amount of experience with e-Detailing, providing a framework for sustainment. Sustainability The VA e-Detailing program is now an integral part of academic detailing in VHA. In fiscal year 2020, 20% of academic detailing visits nationally were e-Detailing visits (28% of visits at the pilot sites were e-Detailing visits) and 73% of all academic detailers (135 of 186) recorded an e-Detailing visit. Due to changes brought by the COVID-19 pandemic, early barriers such as provider discomfort with video communication and lack of telehealth video equipment were largely resolved. Technical barriers with video quality are no longer a major issue. VVC is now a part of the new provider training, and video visits are intended to be a significant element of ongoing outpatient care. Additionally, lessons learned from implementing e-Detailing will help to improve adoption across VA (Box 1). Box 1. Lessons Learned From Implementing e-Detailing • Perceptions of cross-facility coverage: ◦ Detailer may be viewed as an expert in one field but has trouble connecting with providers on topics outside that field. ◦ Differences in personalities may prevent a detailer from building rapport with certain providers; sometimes a new detailer is able to build a positive, productive relationship with those providers. • Regular facilitation calls provided a forum for academic detailers to share their experiences and resources. • In-person training gave participants live exercises to troubleshoot various technical issues with VA Video Connect and prepare them for encounters with providers. • Metric-based performance provided an incentive for facilities to deliver e-Detailing and helped to expand the program to other facilities. • Detailers and some providers noted the importance of support from leadership and providing dedicated time for providers to meet with detailers, as well as direct and ongoing technological support, including direct technological support as well as dedicated time or encouragement to support providers in engaging with detailers. • The COVID-19 pandemic presented new challenges to delivering effective detailing but also resolved outstanding barriers due to widespread adoption of telehealth in regular care. • Detailers and some providers also noted that e-Detailing may be more effective with short-interaction, discrete initiatives rather than supporting providers on long-term efforts; however, more work needs to be done to determine the most effective applications of e-Detailing. • Multiple detailers noted the importance of the e-Detailing training and ongoing implementation facilitation efforts in supporting detailing efforts. • Detailers noted effective strategies used to secure visits include offering technical assistance for telehealth technology, initial meetings for in-person and e-Detailing for follow-ups, and leadership participation in academic detailing scheduling. Conversely, e-Detailing was limited in its effectiveness without leadership support. • Detailers believed e-Detailing was equally effective as in-person academic detailing for rural/remote providers and that additional effort such as follow-up visits are necessary to improve academic detailing effectiveness. • Some rural/remote providers felt they received support from leadership, while others believed leadership implements changes without understanding outlying clinics. For example, those who felt neglected reported lack of resources in scheduling patients for specialty care. • Providers did not have trouble with technology, which may have been due to technical assistance provided by detailers. • Perceptions of cross-facility coverage: ◦ Detailer may be viewed as an expert in one field but has trouble connecting with providers on topics outside that field. ◦ Differences in personalities may prevent a detailer from building rapport with certain providers; sometimes a new detailer is able to build a positive, productive relationship with those providers. • Regular facilitation calls provided a forum for academic detailers to share their experiences and resources. • In-person training gave participants live exercises to troubleshoot various technical issues with VA Video Connect and prepare them for encounters with providers. • Metric-based performance provided an incentive for facilities to deliver e-Detailing and helped to expand the program to other facilities. • Detailers and some providers noted the importance of support from leadership and providing dedicated time for providers to meet with detailers, as well as direct and ongoing technological support, including direct technological support as well as dedicated time or encouragement to support providers in engaging with detailers. • The COVID-19 pandemic presented new challenges to delivering effective detailing but also resolved outstanding barriers due to widespread adoption of telehealth in regular care. • Detailers and some providers also noted that e-Detailing may be more effective with short-interaction, discrete initiatives rather than supporting providers on long-term efforts; however, more work needs to be done to determine the most effective applications of e-Detailing. • Multiple detailers noted the importance of the e-Detailing training and ongoing implementation facilitation efforts in supporting detailing efforts. • Detailers noted effective strategies used to secure visits include offering technical assistance for telehealth technology, initial meetings for in-person and e-Detailing for follow-ups, and leadership participation in academic detailing scheduling. Conversely, e-Detailing was limited in its effectiveness without leadership support. • Detailers believed e-Detailing was equally effective as in-person academic detailing for rural/remote providers and that additional effort such as follow-up visits are necessary to improve academic detailing effectiveness. • Some rural/remote providers felt they received support from leadership, while others believed leadership implements changes without understanding outlying clinics. For example, those who felt neglected reported lack of resources in scheduling patients for specialty care. • Providers did not have trouble with technology, which may have been due to technical assistance provided by detailers. Open in new tab • Perceptions of cross-facility coverage: ◦ Detailer may be viewed as an expert in one field but has trouble connecting with providers on topics outside that field. ◦ Differences in personalities may prevent a detailer from building rapport with certain providers; sometimes a new detailer is able to build a positive, productive relationship with those providers. • Regular facilitation calls provided a forum for academic detailers to share their experiences and resources. • In-person training gave participants live exercises to troubleshoot various technical issues with VA Video Connect and prepare them for encounters with providers. • Metric-based performance provided an incentive for facilities to deliver e-Detailing and helped to expand the program to other facilities. • Detailers and some providers noted the importance of support from leadership and providing dedicated time for providers to meet with detailers, as well as direct and ongoing technological support, including direct technological support as well as dedicated time or encouragement to support providers in engaging with detailers. • The COVID-19 pandemic presented new challenges to delivering effective detailing but also resolved outstanding barriers due to widespread adoption of telehealth in regular care. • Detailers and some providers also noted that e-Detailing may be more effective with short-interaction, discrete initiatives rather than supporting providers on long-term efforts; however, more work needs to be done to determine the most effective applications of e-Detailing. • Multiple detailers noted the importance of the e-Detailing training and ongoing implementation facilitation efforts in supporting detailing efforts. • Detailers noted effective strategies used to secure visits include offering technical assistance for telehealth technology, initial meetings for in-person and e-Detailing for follow-ups, and leadership participation in academic detailing scheduling. Conversely, e-Detailing was limited in its effectiveness without leadership support. • Detailers believed e-Detailing was equally effective as in-person academic detailing for rural/remote providers and that additional effort such as follow-up visits are necessary to improve academic detailing effectiveness. • Some rural/remote providers felt they received support from leadership, while others believed leadership implements changes without understanding outlying clinics. For example, those who felt neglected reported lack of resources in scheduling patients for specialty care. • Providers did not have trouble with technology, which may have been due to technical assistance provided by detailers. • Perceptions of cross-facility coverage: ◦ Detailer may be viewed as an expert in one field but has trouble connecting with providers on topics outside that field. ◦ Differences in personalities may prevent a detailer from building rapport with certain providers; sometimes a new detailer is able to build a positive, productive relationship with those providers. • Regular facilitation calls provided a forum for academic detailers to share their experiences and resources. • In-person training gave participants live exercises to troubleshoot various technical issues with VA Video Connect and prepare them for encounters with providers. • Metric-based performance provided an incentive for facilities to deliver e-Detailing and helped to expand the program to other facilities. • Detailers and some providers noted the importance of support from leadership and providing dedicated time for providers to meet with detailers, as well as direct and ongoing technological support, including direct technological support as well as dedicated time or encouragement to support providers in engaging with detailers. • The COVID-19 pandemic presented new challenges to delivering effective detailing but also resolved outstanding barriers due to widespread adoption of telehealth in regular care. • Detailers and some providers also noted that e-Detailing may be more effective with short-interaction, discrete initiatives rather than supporting providers on long-term efforts; however, more work needs to be done to determine the most effective applications of e-Detailing. • Multiple detailers noted the importance of the e-Detailing training and ongoing implementation facilitation efforts in supporting detailing efforts. • Detailers noted effective strategies used to secure visits include offering technical assistance for telehealth technology, initial meetings for in-person and e-Detailing for follow-ups, and leadership participation in academic detailing scheduling. Conversely, e-Detailing was limited in its effectiveness without leadership support. • Detailers believed e-Detailing was equally effective as in-person academic detailing for rural/remote providers and that additional effort such as follow-up visits are necessary to improve academic detailing effectiveness. • Some rural/remote providers felt they received support from leadership, while others believed leadership implements changes without understanding outlying clinics. For example, those who felt neglected reported lack of resources in scheduling patients for specialty care. • Providers did not have trouble with technology, which may have been due to technical assistance provided by detailers. Open in new tab The future of academic detailing in VHA will continue to involve a variety of communication mediums to bring academic detailers and providers together to have important conversations about the best evidenced-based approaches to delivering high-quality patient care. Research to determine the relative effectiveness of e-Detailing compared to traditional in-person academic detailing is ongoing. Though the results of this study are not yet available, there appears to be an acceptance of e-Detailing at VA as part of the routine practice delivered by academic detailers. Further investigation will also need to evaluate the impact of e-Detailing on academic detailer burnout. The convenience and quality of e-Detailing versus a phone visit, and the ability to flexibly complete visits on demand while approximating many of the visual cues of an in-person face-to-face visit provide convincing justifications for e-Detailing to continue. Conclusion As the nation’s largest provider of telehealth, VA continues to expand telehealth options across the country. Training, support, an implementation pilot, and ongoing facilitation have allowed PBM Academic Detailing Service to harness clinical pharmacist specialists’ abilities to provide unique e-Detailing services across VA. VA academic detailers are encouraged to utilize VVC for their virtual detailing visits to promote its use and ensure optimization of educational outreach visits with providers. With the need for VA to be able to provide accessible care to veterans across the United States and its territories, e-Detailing is poised to continue supporting and spreading VA virtual modalities. This article is part of a special AJHP theme issue on telehealth. Contributions to this issue were coordinated by Michael J. Miller, BSPharm, DrPH, FAPhA; Sandra L. Kane-Gill, PharmD, MS, FCCM, FCCP; and Hae Mi Choe, PharmD. Acknowledgments The authors acknowledge the leadership of VA Pharmacy Benefits Management (Michael Valentino and Virginia Torrise) and the amazing work of every VA academic detailer. Support from our colleague, Hannah Cheng, at the VA Center for Innovation to Implementation allowed us to perform the qualitative assessments. Disclosures The authors have declared no potential conflicts of interest. Additional information The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agencies of the US government. References 1. S.2372 – VA MISSION Act of 2018: 115th Congress (2017-2018). Congress.gov . Accessed April 28, 2021 . https://www.congress.gov/bill/115th-congress/senate-bill/2372/text 2. Reddy A , Fihn SD, Liao JM. The VA MISSION Act — creating a Center for Innovation within the VA . N Engl J Med. 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TI - Implementation of a pharmacy-led virtual academic detailing program at the US Veterans Health Administration
JF - American Journal of Health-System Pharmacy
DO - 10.1093/ajhp/zxac024
DA - 2022-05-24
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SP - 909
EP - 917
VL - 79
IS - 11
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