Academic detailing technique may help doctors follow treatment guidelines

Researchers often get frustrated when doctors fail to adopt treatment guidelines backed by the best evidence-based research.

But a study published in the May 24, 2010, Archives of Internal Medicine found that using techniques similar to those employed by pharmaceutical sales reps can help persuade doctors to follow the guidelines.

Like drug sales representatives, researchers in the study met with small groups of doctors, especially opinion leaders. They detailed guidelines for treating high blood pressure, and handed out studies, newsletters, pocket cards, exam room posters, etc. An examination of prescribing patterns found that this technique, known as "academic detailing," influenced what drugs doctors prescribed.

"This study makes the case that academic detailing can work," said Dr. Paul Whelton, senior author of the study and president and CEO of Loyola University Health System. Whelton is national chairman of the landmark trial that led to the blood pressure guidelines, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). First author is Dr. Randall Stafford of Stanford University.

Many studies have found that evidence-based treatment guidelines are adopted slowly and incompletely by doctors. "There's a huge gap between doing science and translating the findings into action," Whelton said. "It's frustrating when evidence-based guidelines aren't followed."

Based on results of the ALLHAT trial, the National Heart, Lung and Blood Institute issued treatment guidelines for treating high blood pressure. The guidelines recommend that most patients should take a generic diuretic drug that is effective in preventing cardiovascular complications of high blood pressure. A diuretic typically costs $25 to $40 per year. By comparison, newer brand-name hypertension drugs can cost thousands of dollars per year.

Pharmaceutical sales reps often are called "detailers" because they provide details about the benefits, side effects, etc., of drugs. Pharmaceutical companies employ about 60,000 detailers in the United States.

The academic detailing in the Archives study was small by comparison. It included 147 researcher-educators who reached 18,524 physicians in 41 states. The academic detailers typically made one presentation per month and were paid $400 per presentation to cover the cost of a light meal or snack, travel and honorarium.

In counties with the most academic detailing activities, there was a 8.6 percent increase in the percentage of patient visits in which the physician prescribed the recommended diuretics. In counties with the least amount of academic detailing, there was a 2 percent decrease in prescribing the recommended drug.

In the Archives paper, researchers concluded that academic detailing "has the potential to improve prescribing patterns but may require greater intensity to facilitate translation of clinical trails evidence into community practice."