Appendix 4 : PrISM Questionnaire & Follow-Up

Section I: Needs Assessment and Key Messages

1. Who is responsible for AD topic selection (e.g. committee of practitioners, board of directors, etc.)?

  • No formal committee of practitioners or directors
  • Topics generated by executive director and drug evaluation pharmacist based on:
    • Discussion with target physicians (informal)
    • Review of medication error literature (generated fentanyl, SL nifedipine, vitamin K and spironolactone topics)
    • Recommendations from the MPhA council/Registrar (generated Vioxx® newsletter and omeprazole IC – pharmacist newsletter)

2. What process is used to select AD topics? In other words what, if any, formal “Needs Assessment” is conducted to determine an AD topic?

  • Usually no formal needs assessment conducted
  • Utilized TPB survey (include TPB survey) when developing materials on Benzodiazepines and BB in Heart failure during the READ trial. The goal of this survey was to determine the attitudes and intentions of physicians towards prescribing these agents. This information was used to tailored intervention material to deal with barriers to optimum prescribing practices.

3. Once a topic is chosen, who is responsible for development of “Key Message”?

  • Executive Director or drug evaluation pharmacist.

4. What process is utilized, or what considerations are made, when developing “Key Messages”? (E.g. does each key message have to result in a measurable outcome?)

  • Key messages are developed based on the literature assessment of the topic and in the READ Study topics, based on TPB survey (dealing with specific prescribing tendencies)
  • Not all key messages result in measurable outcomes.

5. Do you have a set number of key messages for each topic, or can any number of messages be chosen?

  • No set number of key messages, generally 5 or less.

Section II: Academic Detailer Training and Background Material

1. Who is responsible for training Academic Detailers on an AD topic?

  • Because there are only two of us working within the organization, and we are both involved in the production and review of AD materials, there is no need for formal training process on AD topics.

2. How is Detailer training conducted (e.g. group tutorials, teleconference training, etc.)? Where is the training held and how long does training usually take?

  • As above there is no formal training process.
  • However, because those involved in material development are also detailing, the detailer is well versed in the primary literature used to develop the material. The detailer has read the primary literature as well as any meta-analysis or critical reviews that are pertinent to the topic.

3. What materials are routinely involved in the training of Academic Detailers (e.g. power point presentations on topics)? Please provide examples of training materials employed by your organization in Detailer training.

  • See answer to #2 in this section

4. What background materials or support materials on an AD topic are provided to detailers to ensure they are well enough versed in the topic to conduct physician visits (e.g. detailed summary documents, primary literature, etc.)? Please provide examples of materials developed by your program that act as background or support materials for detailers.

  • Topic Background document (25-35 pages)
  • Topic Newsletter (2-4 pages)
  • Any patient tools or prescribing aids developed for the specific topic
  • File kept of all primary literature and reviews used to generate detailing materials

5. Do you conduct any type of knowledge assessment or testing of detailers to assess the effectiveness of training for AD topics?

  • No formal knowledge assessment. Detailer involved with all aspects of material development, so competence within the topic is assumed.

6. Are there any mechanisms put into place within your organization to provide ongoing support to Detailers on a specific AD topic (e.g. access to clinical experts for follow-up questions, etc.)?

  • The person detailing has access to the other person within the organization to discuss controversy or questions generated by physicians.
  • Clinical experts contacted on an as-needed basis for questions that cannot be resolved internally

Section III: Academic Detailing Material for Primary Care Practitioners

1. Who is responsible for the production of AD materials in your organization (e.g. internal staff, contract experts, etc.)?

  • Internal staff produces all of the AD materials.
  • Clinical experts utilized to review material (usually one pharmacist reviewer and one physician reviewer)

2. Briefly describe the types of AD materials produced by your organization, and provide examples of the materials. If possible, please categorize the AD materials you produce into one of the following groups:

  • Newsletters
    • Spectrum (pharmacist)
    • SpectrumMD (physicians)
    • Between 2-4 pages long
    • Fairly detailed review of literature on a topic.
    • Referenced document.
    • Utilizes a “Key Messages” box usually on the front pag
    • Numerous examples provided
  • Prescribing Aids (e.g. titration guides, quick reference cards, reference charts)
    • No “standard” prescribing aids (ex. RxFile charts)
    • Prescribing aids produced as needed to fit a specific topic, examples:
      • beta-blocker titration in HF instructions
      • Benzo weanin
      • COPD exacerbation management chart
  • Patient Materials
    • Not regularly produced
    • One document, in relation to the Benzodiazepine AD project
    • Difficult material to produce with regard to language and format
  • In addition to above, produce a background document (25-35 pages) to act as a reference document for detailing purposes. (example of Statin reference document provided).

3. Is there any standard formatting or branding used in the AD materials your organization produces?

  • The newsletters have a standard look with the logo and PrISM title across the top and the name of the newsletter down the left-hand side.
  • Prescribing aids and patient material produced ad hoc so no specific formatting.

4. How are AD materials utilized during an AD intervention (e.g. are all materials brought by detailer or are some materials mailed out ahead of time)?

  • Newsletter sent to all family physicians in the province
  • Additional materials (prescribing aids, patient information, case examples, detail documents) brought to the physician’s office during AD visit.

5. Are their AD materials you would like to produce or have access to that you currently do not? What barriers are there to the production of these materials?

  • Patient specific materials are difficult to produce and would be useful to provide to physicians.
  • Not produced due to lack of expertise in producing patient material and lack of resources to produce in sufficient quality

Section IV: Impact Evaluation

1. Describe the types of Impact Evaluation conducted by your organization to assess the effectiveness of an AD intervention. If reports of Impact Evaluation are available, please provide. Please also include any examples of informal evaluation, surveys or evaluation efforts that are still in process.

  • Web and paper-based satisfaction survey of Spectrum Newsletter to all Manitoba pharmacists – analysis ongoing. A similar survey of the SpectrumMD newsletter has not yet been conducted.
  • READ project – was set up in a cluster RCT evaluative framework – some significant sample size limitations exist. Data analysis requires ethics and privacy approvals.

2. What data sources, if any, must be accessed to conduct the Evaluation (e.g. provincial drug databases, “linked” healthcare databases)?

  • The Pharmacare/DPIN database contains records of all prescription products filled in Manitoba pharmacies. If outcome evaluation can be measured by prescribing data alone then this database is adequate. As a general rule Pharmacare/DPIN data must be accessed through the Manitoba Centre for Health Policy. This centre is able to link data with other healthcare databases. Access to this data requires involvement of a researcher from the centre, ethics approval, privacy approval, and funding to pay for the programming time required to capture the data. All data would be scrambled identifiers with a minimum of five data points per postal code area.

3. Who conducts the Impact Evaluation (e.g. conducted by persons within the organization or by external evaluators such as government)?

  • Impact evaluation would be planned and organized by PrISM staff. As indicated above, access to the Pharmacare/DPIN database would require a partnership with researchers at the Manitoba Centre for Health Policy.