UBC Theses and Dissertations
Family physician's perceptions of academic detailing for rheumatoid arthritis Chhina, Harpreet Kaur
Rheumatoid arthritis (RA) is a chronic inflammatory polyarthritis, affecting 1% of the adult population, which left untreated can lead to progressive physical disability, joint damage, and premature mortality. In the last decade, there has been a paradigm shift in the treatment of RA, with its goal being eradication of inflammation. This message of paradigm shift in the treatment to early, aggressive and sustained use of Disease Modifying Anti-Rheumatic Drugs, has not yet reached all Family Physicians (FPs). Academic Detailing (AD) involving visits by trained health care professionals, like pharmacists, to physicians in their offices to provide evidence based information on a selected topic, seems to be a promising technique to influence the behaviour of FPs. To our knowledge, there are no publications of use of AD for RA. Our study, through a mixed methods approach, aims to fill this knowledge gap for understanding FPs perceptions of AD for RA management. Before investing in implementation of AD for RA as a health service strategy, it is necessary to know if FPs perceive AD as a useful, acceptable and feasible technique to receive information about RA management. Our systematic review showed the effectiveness of AD at optimizing prescription behaviour of FPs, with a modest effect size in majority of studies reviewed. Survey findings suggested that most FPs rated AD as a useful and convenient CME technique and is well accepted. FPs appreciated AD for its educational value, convenience, one-on-one interaction, short duration; subject expert review of content, and practical, evidence based and focused content. Some FPs mentioned disadvantages like difficulty incorporating AD during work days, lack of dedicated CME time, lack of time for detailed discussions, lack of time to consult information provided by AD, and delivery of standardised messages. AD was acceptable to most FPs as demonstrated by the outcomes of this visit, including improved confidence, anticipation of changes in RA management and willingness to receive AD in future. Overall, AD was perceived as a useful, acceptable and feasible CME technique, by FPs, to receive information about RA management and hence to optimize care.
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