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CADTH » Resources » Academic Detailing Templates » Academic Detailing Material Overview » Prescribing Aids - Template Recommendations

Prescribing Aids - Template Recommendations

The template recommendations for developing prescribing aids will build on the previous template recommendations made for newsletters. The design recommendations for formatting and content of newsletters generally apply equally to prescribing aids, although specific content items like the need for highlighted key messages may or may not apply depending on the nature of the prescribing aid. Additional recommendations on prescribing aids provided below are based on our experience with the development of academic detailing material, our survey of eight academic detailing organizations based in Canada, the United States and Australia, and the catalogued evaluation of 20 prescribing aids from these organizations. Separate template recommendations are provided for two types of prescribing aids that we evaluated: Drug/Disease References and Risk Calculators. The third type of prescribing aid we evaluated was the Case Studies. Since they are largely text-based, they tend to be similar to newsletter and as such we have no further template recommendations for this type of product. Following the template recommendations are recommendations on which prescribing aid should be chosen based on type of detailing intervention and desired outcome. All individual documents discussed in the recommendations are available in Appendix 29.

Drug/Disease Reference Recommendations

Charts are commonly employed in the provision of information on drugs and/or diseases. This is an efficient method of providing concise comparative information. The challenge when creating a Drug/Disease Reference chart is to balance the quantity of information with the readability and/or usability. To illustrate this challenge, we will highlight two charts from the RxFiles.

  • Oral Antihypertensives Summary/Guidelines Comparison Chart (PA – 04) provides an extremely large amount of information to facilitate therapeutic decision-making. Arguably, all necessary prescribing information for the use of all antihypertensives is contained in 2 pages. However, in order to achieve this degree of information density, the text is densely packed into the charts; there is use of exceptionally small font, use of inset boxes of additional information, haphazard application of highlighting and use of acronyms and symbols. As discussed within the evaluations, prescribing aids like this are highly utilized and appreciated amongst practitioners accustomed to the RxFiles style of material. However, the understanding of how to use the material has been brought about by the long-standing relationship that the RxFiles academic detailers have with their “consumers”. New programs should avoid developing material this highly stylized because of the wide audience it must appeal to and the lack of academic detailing support it may receive in many jurisdictions.

  • Inhalation Devices and Monitoring Tools (PA – 03) provides a comprehensive review of another group of medical products. There is far less information to communicate about these products (compared with all drugs used in the management of hypertension), hence only one page worth of content. Because of the limited amount of information to provide, one can see the sharp improvement in format and readability. The larger text size, more consistent use of highlights and bullets and minimal use of acronyms and symbols provides a far easier-reading document.

Risk Calculator Recommendations

Applying the creative use of graphics to a risk calculator can improve both its aesthetics and usability. To illustrate this we will highlight two Framingham-based risk calculators:

  • Assessing Cardiovascular Risk and Treatment Benefit (PA – 18) provides a brightly coloured graphics-based cardiovascular risk calculator. In order to utilize the chart, the practitioner must identify the correct graph based on the patient’s sex, diabetes status and age. Then the actual risk level is determined by cross-referencing the patient’s blood pressure and cholesterol. The exercise requires no calculations or cumulative scoring.

  • Model for Estimating the 10-Year Risk of Coronary Artery Disease (PA – 13) provides a monochromatic, calculation-based cardiovascular risk calculator. In order to utilize the calculator the practitioner must systematically follow the chart vertically and (at points) horizontally, keeping a running total of the patient’s “score”. Utilizing this calculator is likely more prone to error (due to the need for active calculation) and likely more time consuming.

The comparison of the above two Risk Calculators highlights another recommendation.

The former document (PA – 18) provides an evaluation of treatment efficacies in patients at varying degrees of risk. It incorporates some form of therapeutic decision support to supplement the information gained through the use of the calculator. The latter document (PA – 13) provides only the results of the calculation. Incorporating some form of therapeutic decision support with the risk calculator will enhance its usability to the primary care practitioner.

Prescribing Aid Utilization Recommendations

We have catalogued and evaluated three broad types of prescribing aids that can be developed to compliment an academic detailing intervention. The best choice of prescribing aid is highly dependent on the type of intervention. The following outline the characteristics of an intervention that fit with each type of prescribing aid.

  • Drug/Disease references are most applicable in detailing interventions on conditions that have numerous therapeutic options for management. They are especially useful when these therapeutic options differ greatly in mechanism, side effect, price and/or effectiveness. From the catalogue of prescribing aids we have collected examples of conditions that lend themselves to the use of a drug/disease reference including hypertension (PA-04) and community acquired pneumonia (PA-12). Another detailing intervention that lends itself to a drug/disease reference is one where the target prescribing behaviour is complex. Examples of this would be step-based therapies (ex. benzodiazepine titration, PA-09) or disease states where different populations require different treatment strategies (hypertension management based on comorbidities, PA-16).

  • Risk calculators are a far more specialized tool, applicable in very limited academic detailing interventions. Essentially, risk calculators can only be used in interventions where research has quantified the contribution of various factors on an overall risk profile for individual patients. The most commonly applied example is cardiovascular risk calculators (PA-13, PA-18); however, other conditions such as certain forms of cancer, fractures and infectious diseases have validated risk scorings.

  • Case studies are potentially applicable in a wide variety of academic detailing interventions. A case study provides a “real life” scenario to prescribing recommendation and assists with envisioning how a recommendation could be implemented in the treatment of their patients. Most conditions and prescribing behaviours lend themselves to the production of cases studies. In the absence of more direct prescribing aids, cases studies may be appropriate to illustrate complicated clinical issues. In situations where other prescribing aids are available, case studies are used as supplementary materials that can be used during individual detailing sessions.