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History

Academic detailing, which uses interactive outreach strategies to “market” the best evidence on clinical decisions to medical practitioners, is based on the observation that passive continuing medical education by itself is not enough to improve patient care. By contrast, the proactive behavior-change strategies employed by pharmaceutical companies, which include visiting doctors in their offices and engaging in responsive give-and-take discussions with them based on the practitioner’s own particular knowledge, attitudes, and practices, is quite effective in influencing drug choices. In 1979, a federal research agency put out a request for proposals on how best to improve the quality and economy of prescription drug use. An application submitted by Dr. Jerry Avorn of Harvard Medical School proposed combining non-commercial academic overviews and syntheses of the best possible evidence with the interactive, one-on-one outreach employed by the drug industry (“detailing”).  The approach was tested in a four-state controlled trial involving 435 physicians who were randomized to serve as controls or to receive the new approach, delivered by specially trained nurses and pharmacists.  Analysis of the resulting prescribing patterns in the Medicaid program revealed a 14% reduction in problematic drug choices among physicians randomized to receive academic detailing visits, and was published in The New England Journal of Medicine in 1983. A similar approach employed by a team of researchers at Vanderbilt University Medical School was published later that year in the Journal of the American Medical Association, also demonstrating  success in improving doctors’ medication choices. A subsequent benefit-cost analysis of the Harvard study found that it saved the Medicaid program two dollars for every dollar spent on program operations.

In the years since, academic detailing programs have proliferated in several U.S. states, Canadian provinces, and other countries throughout the world. Australia launched a continent-wide program of academic detailing that currently serves over half of that nation’s primary care physicians. By 2007, a review of the literature by the Cochrane Collaborative identified 69 randomized controlled trials of academic detailing, and found strong evidence that the approach is effective in improving the use of medications and other clinical decisions.