Academic Detailers – Clinical Outreach Educators
Academic detailers are healthcare professionals, often with backgrounds in pharmacy, nursing, or public health, who engage in face-to-face education and outreach to provide evidence-based information to other healthcare providers. Academic detailers provide personalized, evidence-based education to healthcare professionals, including primary care providers, specialists, pharmacists, nurses, and healthcare administrators, to improve patient care and outcomes. They operate across diverse contexts such as primary care practices, hospitals, community pharmacies, public health campaigns, telehealth, and policy settings, tailoring interventions to specific needs and environments. One critical need that academic detailers help to address is assisting physicians in expanding treatment to those with substance use disorders. In the context of promoting substance use treatment, they work to improve knowledge, attitudes, and practices around substance use disorders (SUD) among clinicians. Here’s how academic detailers help promote substance use treatment:
- Providing Evidence-Based Guidelines: Academic detailers share the latest research and treatment guidelines for substance use disorders, including options for medications for treating substance use disorders like buprenorphine, methadone, and naltrexone. They help ensure that clinicians have accurate, up-to-date knowledge about topics such as treatment efficacy, safety, dosing, drug interactions, behavioral components of taking the medications, and medication adherence.
- Addressing Misconceptions: There are a lot of misconceptions around patient relapse and medications for treating substance use disorders. Detailers often work to dispel myths or stigma surrounding substance use disorder treatment. By addressing these issues, they help foster a more accepting and supportive environment for substance use disorder treatment.
- Improving Screening and Diagnosis: Academic detailers encourage providers to incorporate validated screening tools and assessments for substance use disorders into routine care. This can lead to earlier identification of patients with substance use issues and quicker access to treatment.
- Supporting Best Practices for Prescribing: For clinicians who prescribe opioid pain medications, detailers may offer guidance on best practices for opioid prescribing for pain to reduce substance use and dependency. They also promote safer prescribing practices for medication for substance use, including co-prescribing Naloxone with opioid pain medications (NARCAN®, a medication that reverses opioid overdose), proper dosing, monitoring, and support for tapering when appropriate.
- Connecting Providers with Resources: Academic detailers often serve as a warm hand off between healthcare providers and local resources, such as substance use disorder specialists, behavioral health services, and community support groups. This helps clinicians build a network of support for their patients and ensures continuity of care.
- Encouraging Patient-Centered Approaches: Detailers emphasize patient-centered, nonjudgmental care approaches, encouraging clinicians to view substance use disorders as chronic, reoccurring, treatable conditions rather than moral failings. This shift in perspective can improve provider-patient relationships and lead to better treatment outcomes.
- Enhancing Provider Confidence: Many clinicians may feel uncertain or uncomfortable managing substance use disorder due to a lack of training. Academic detailers provide education, answer questions, and offer support, which can boost providers’ confidence and willingness to engage in substance use disorder treatment.
- Monitoring and Feedback: Academic detailers may also help providers by gathering and reviewing data on patient outcomes related to substance use disorder treatment practices. They can provide feedback on how the provider’s interventions are impacting patient care, thereby fostering continuous improvement.
By building knowledge, changing attitudes, and promoting best practices, academic detailers help expand access to effective, evidence-based substance use disorder treatment within communities, especially in rural or underserved areas where both professional and community or treatment resources may be limited.
Training
If you are interested in becoming an academic detailer, please visit the National Resource Center for Academic Detailing (NARCAD) https://www.narcad.org/training-series.html
As a part of this project, we are creating a cohort of new and established academic detailers to address issues related to substance use prevention, treatment, and recovery. We plan to host regular meetings to share resources, barriers, and solutions. If you provide services in Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, or Texas) and you’d like to learn more about the cohort or join us, please contact Meghan Breckling at MNBreckling@uams.edu.
Project AURA supports training academic detailers who will provide opioid and stimulant use education and guidance to rural providers across Region 6. If you are from one of the states in Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, or Texas) and are interested in becoming an academic detailer to address substance use in rural communities, we have training opportunities available.
As a part of this project, we are creating a cohort of new and established academic detailers to address issues related to substance use prevention, treatment, and recovery. We plan to host regular meetings to share resources, barriers, and solutions. If you provide services in Region 6 and you’d like to learn more about the cohort or join us, please contact Meghan Breckling at MNBreckling@uams.edu.
Academic Detailing Toolkits for Substance Use
- Opioid Safety AD Toolkit
- Cannabis Use Disorder AD Toolkit (Coming soon)
- Stimulant Use Disorder AD Toolkit (Coming soon)
Also Health – evidence-based OUD clinical guidelines for academic detailers
– https://alosahealth.org/clinical-modules/oud/
Education for Academic Detailers – VA – pharmacy benefits management services
– https://www.pbm.va.gov/academicdetailingservicehome.asp
One Critical Need
To address overdose rates in rural areas, rural healthcare providers should offer substance use treatment, but many do not. Academic detailers may prompt behavior change in rural healthcare providers to initiate treatment services for those with substance use disorders.
Addressing Opioid Use Disorder and Stimulant Use Disorder in Rural Areas
Providing academic detailing service to rural health care providers addressing Opioid Use Disorder (OUD) and Substance Use Disorder (SUD) has unique barriers and as such, requires unique solutions and resources. Let us help you navigate this process so you feel well-equipped to meet the needs of the rural providers you are serving.
BARRIERS, SOLUTIONS, RESOURCES
Lack of a Physician Support Network
Some healthcare providers may have specific questions for treating those with substance use disorders, and require additional support and training to feel confident in offering these services in their rural clinic.
The academic detailer can recommend that the healthcare provider attend Project ECHO and provide access to the PCSS Now Mentoring program. Both resources provide access to other healthcare providers that can answer questions when beginning to offer substance use treatment.
Time Restraints
Some healthcare providers may feel that they do not have the capacity to treat those with substance use disorders due to an already full schedule of patients.
To bridge this barrier, the academic detailer may suggest that the healthcare provider attend Project ECHO or access available peers on the PCSS Now Mentoring program to identify how other rural providers manage the workload of treating both those with and without substance use disorders in a clinic that may already be at capacity.
Legal Regulations
Each state has various legal regulations around MOUD prescribing and treating substance use disorders. Healthcare providers may have a lack of knowledge in this area, and this may prevent them from beginning to treat those with substance use disorders.
To bridge this barrier, healthcare providers could attend Project ECHO sessions and utilize the PCSS Now Mentoring program options to connect them to peers in their state that will be able to answer state-specific questions around the legal regulations in place and how to navigate those.
Stigma
Rural healthcare providers may be hesitant to offer substance use treatment out of fear that their clinic will become known for treating these individuals and concerns that it may disrupt the clinic’s usual operations.
Project ECHO and the PCSS Now Mentoring program, are both opportunities to connect with other rural physicians who may have had the same concerns when they began treating OUD and/or SUD. The resources will help them navigate concerns over reputation and stigma.
Geographical Barriers
Rural providers may serve as the primary source of care for a large rural area, and some individuals may not have transportation to travel to the health care provider in person.
Expanding services to include telehealth to treat OUD and SUD may help bridge this barrier. While the initial visit for buprenorphine induction may need to be conducted in person, follow up visits can be conducted via telehealth. Other medications such as Methadone cannot be prescribed and monitored via telehealth visits, and in these cases, Buprenorphine may be the best option to offer for these patients.
Since regulations to offer telehealth visits may vary by state, the academic detailer should research state-specific requirements and explain them to rural healthcare provider during the AD visit.
Lack of Access to Medications
MOUD (Buprenorphine, etc.) may not be available at rural pharmacies, hospitals, and community health care centers.
To bridge this barrier, academic detailers can call to check on availability of MOUD at local pharmacies and health care centers to provide a list of which centers have availability for increased access to healthcare providers and the patients they serve.
Prior to doing an academic detailing visit with a rural provider to support beginning substance use disorder treatment, academic detailers can call to check on availability of MOUD at local pharmacies and health care centers to provide a list of which centers have availability for increased access to healthcare providers and the patients they serve.
Diversion and Off-Label Use
Rural healthcare providers may be concerned that certain medications (e.g., Buprenorphine) may lead to issues with diversion or off-label use
To bridge this barrier, academic detailers should recommend monitoring for off-label use and diversion at each clinical visit. Research suggests using urine drug tests as one method.
A Review of Buprenorphine Diversion and Substance use Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177012/
Adequate Training of Staff
Rural healthcare providers may feel that their clinical staff is not sufficiently trained to care for patients with substance use disorders.
To bridge this barrier, healthcare providers can offer MOUD clinical training for clinical staff. There are free options available such as the PCSS 8-hour MOUD training and ongoing Project ECHO sessions in each state.
Free 8-hour training for MOUD from PCSS Now: https://pcssnow.org/medications-for-opioid-use-disorder/
Co-Occurring Mental Health Issues
One barrier to providing services to those with substance use issues is that providers may feel ill-equipped to treat co-occurring mental health issues. In rural areas, there may be very limited referral options for mental health treatment.
To bridge this barrier, the academic detailer should construct a state- and insurance-specific list of behavioral health providers that offer telecounseling services to share with providers.
Find a provider that offers teletherapy: https://www.psychologytoday.com/us/therapists?category=online-counseling
Teletherapy practice rules by state: https://personcenteredtech.com/teletherapy-practice-rules-by-state/
Financial Concerns
Healthcare providers may be concerned about the barriers to payment for treating those with substance use disorders. Some insurances do not cover MOUD, some patients will not be able to afford the prescribed MOUD, and sometimes the healthcare provider has difficulty getting reimbursed for prescribing MOUD for those with substance use disorders. Research suggests that Medicaid may only cover MOUD for 6 months or less, and rarely extends coverage to 12 or more months.
Insurance: The academic detailer can research which insurances cover each MOUD medication (will be state specific) and for how long each insurance will cover MOUD medication so that the healthcare provider can consider this when treating patients with substance use disorder.
Cost: The academic detailer can research differences in costs for each MOUD in the state to inform the healthcare provider of cheaper alternatives if a prescribed medication is too expensive for their patient.
Medicaid Reimbursement: The academic detailer can recommend that the healthcare provider attend Project ECHO and PCSS Now Mentoring program. This will give them access to other healthcare providers that currently prescribe MOUD and ways to navigate Medicaid reimbursement.
SAMHSA Medicaid PDF: https://store.samhsa.gov/sites/default/files/medicaidfinancingmatreport_0.pdf
Resources: Project ECHO
Many Project ECHO hubs have lines that focus on training healthcare providers to offer MOUD services in their clinics.
For example, TxRx ECHO program, a Texas based ECHO line that provides telementoring in utilizing medications to treat substance use disorders, including medications for alcohol, opioid, and stimulant substance use disorders. This program targets prescribers, and other providers who support medications for substance use disorder services for patients. This includes topics such as assessment, induction, treatment, referrals to higher levels of care, and ongoing longer-term care or wrap-around services. Healthcare providers can attend meetings virtually to get additional training in these topics and can contact the presenters for additional mentoring and to answer specific questions. While some questions may be specific to the state of origin (e.g., rules and regulations of treating with MOUD), some may be more general and healthcare providers may benefit from attending Project ECHO sessions that are offered in other states.
- Arkansas Project ECHO
- New Mexico Echo: Alcohol and Mental Health
- New Mexico Echo: Medication for Opioid Use Disorder
- Oklahoma ECHO: Addiction Medicine TeleEcho
- Texas Echo: TxRx
- Texas Echo: Support Hospital Opioid Use Disorder Treatment
- Full list of state-specific Project ECHO lines
Resources: PCSS NOW Mentoring Program
The PCSS Now Mentoring Program (https://pcssnow.org/mentoring/) is a national network of trained clinicians with expertise in treating substance use disorders, co-occurring mental disorders, and main management.
There are three mentoring options available to support healthcare provider needs at no cost.
Option 1: Discussion Forum
An online discussion forum moderated by addiction specialists where health professionals can post questions and receive answers from clinical experts and other colleagues. This discussion board is for educational purposes only. Questions should not include patient specific information but should be general in nature. Please reach out to PCSS-MOUD with any questions. Register to join the discussion forum here.
Option 2: Ask a Clinical Question
A simple and direct way to receive an answer related to Substance Use Disorder, Opioid Use Disorder, and other related topics. Designed to provide a prompt response to clinical questions via email. https://pcssnow.org/mentoring/ask-a-clinical-question/
Option 3: One on One Mentoring
Provides individualized, one-on-one guidance via email, phone, or in-person (if feasible), to discuss specific clinical issues. Members are paired with a mentor in their region. This is the most in-depth of the three PCSS-MOUD mentoring tools.
Please contact pcssmentoring@aaap.org to receive a mentor request form.
How To Schedule an Academic Detailing Visit
Project AURA offers academic detailing to Region 6 states (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) for both opioid safety/stewardship and substance use disorders- specifically treating individuals with opioid and stimulant use disorder. To request an academic detailing visit on one of these two topics, you may contact Project AURA.
