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2019 HSR&D/QUERI National Conference Abstract

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4137 — Comparison of full-time and part-time academic detailing on naloxone prescribing at the Veterans Health Administration

Lead/Presenter: Mark Bounthavong,  Resource Center - HERC
All Authors: Bounthavong M (VA Health Economics Resource Center (HERC), VA Palo Alto Health Care System), Harvey MA (VA National Academic Detailing Service, VA Central Office Pharmacy Benefits Management), Oliva EM (VA Program Evaluation and Resource Center, VA Office of Mental Health Operations) Christopher MLD (VA National Academic Detailing Service, VA Central Office Pharmacy Benefits Management)

Objectives:
To examine the impact of academic detailing full time equivalent employee (FTEE) assignment to Veterans Health Administration's (VHA) academic detailing program and its impact on naloxone prescribing.

Methods:
A retrospective cohort study using a fixed effects model was performed to examine the impact of varying FTEE allocation levels for academic detailing on naloxone prescribing in VHA between 09/01/2016 to 09/30/2018. Previous descriptive analysis identified that a cutoff of 0.4-FTEE was associated with greater return on investment. We sought to determine whether this cutoff was associated with naloxone prescribing and compared providers who had an interaction with an academic detailer that was allocated > = 0.4-FTEE to providers who interacted with an academic detailer who was allocated < 0.4-FTEE. Sensitivity analyses explored cutoffs at 0.25-, 0.5-, 0.75-, and 1.0-FTEE.

Results:
Overall, 80,395 naloxone prescriptions were prescribed by 18,302 providers (2,657 exposed and 15,645 unexposed to academic detailing with a mean of 14.4 versus 2.6 prescriptions per provider, p < 0.001). Providers exposed to academic detailing were, on average, 53.8 years old, 51% female, 73% physicians, and had worked at VHA for 118 months at baseline. In the fixed effects model, the average monthly number of naloxone prescribed increased by 0.03 prescriptions among providers who received an educational outreach from an academic detailer who was allocated > = 0.4-FTEE (p < 0.001). For providers who received educational outreach from an academic detailer with < 0.40-FTEE allocated, the average monthly number of naloxone prescribed increased by 0.02 prescriptions (p < 0.001). There was a 50% greater increase in the average monthly number of naloxone prescriptions prescribed among providers who received an OEND-related educational outreach visit from an academic detailer who was allocated > = 0.4-FTEE compared to a similar provider who received their educational outreach from an academic detailer with < 0.4-FTEE allocated (p = 0.021). Sensitivity analyses on other cutoffs indicated that greater FTEE was significantly associated with greater naloxone prescribing.

Implications:
Increased academic detailing FTEE allocation was associated with increased naloxone prescribing among VHA prescribers.

Impacts:
Implementing academic detailing needs to consider the amount of dedicated time for detailers, especially given competing VHA priorities. This observational study highlights the potential benefits of academic detailers having at least 0.4-FTEE (e.g., greater naloxone prescribing).