Academic detailing among psychiatrists - feasibility and acceptability.

Purpose Research has shown that academic detailing (AD), which includes repeated in-person educational messages in an interactive format in a physician's office, is among the most effective continuing medical education (CME) forms for improving prescribing practices and reducing drug costs. The purpose of this paper is to investigate AD's feasibility and acceptability as an educational tool among psychiatrists and its ability to facilitate positive changes in antipsychotic prescribing. Design/methodology/approach All psychiatrists practicing in Southwestern Ontario, Canada were invited to participate. Participants (32/299(10.7 percent)) were provided with two educational sessions by a healthcare professional. Participants evaluated their AD visits and completed a pre- and post-AD questionnaire measuring various prescribing practice aspects. Findings A total of 26 out of 32 (81.3 percent) participants completed the post-AD evaluation; most of them (61.5 percent, n=16) felt that AD gave noteworthy information on tools for monitoring side-effects and 50.0 percent ( n=13) endorsed using these in practice. In total, 13 participants (50.0 percent) felt that the AD sessions gave them helpful information on tools for documenting polypharmacy use, which 46.2 percent ( n=12) indicated they would implement in their practice. No significant differences were found between participants' pre- and post-assessment prescribing behaviors. Practical implications There is great need for raising AD program's awareness and improving physician engagement in this process locally, provincially and nationally. Originality/value To the authors' knowledge, this is the first AD program in Canada to target specialists solely. Participant psychiatrists accepted the AD intervention and perceived it as a feasible CME method.

Developing an instrument to measure bias in CME.

INTRODUCTION: The pharmaceutical industry, by funding over 60% of programs in the United States and Canada, plays a major role in continuing medical education (CME), but there are concerns about bias in such CME programs. Bias is difficult to define, and currently no tool is available to measure it. METHODS: Representatives from industry and academia collaborated to develop a tool to illuminate and measure bias in CME. The tool involved the rating of 14 statements (1 = strongly disagree, 4 = strongly agree) and was used to evaluate 17 live CME events. Cronbach's alpha was used to assess the internal consistency of the scale. RESULTS: Cronbach's alpha for the total score was 0.82, indicating excellent internal consistency. Incomplete or biased data, data presented in an unbalanced manner, and experience not integrated with evidence-based medicine were found to correlate strongly with the total score. Use of trade names showed a low correlation with the total, and nondeclaration of conflict of interest correlated negatively with the total. These associations suggest that whereas sponsor companies may declare conflicts of interest, such a declaration may not ensure an unbiased presentation. DISCUSSION: The tool and the data from this study can be used to raise awareness about bias in CME. Policymakers can use this tool to ensure that CME providers meet the standards for education, and CME providers can use the tool for conducting random audits of events they have accredited.

Controlling quality in CME/CPD by measuring and illuminating bias.

INTRODUCTION: There has been a surge of interest in the area of bias in industry-supported continuing medical education/continuing professional development (CME/CPD) activities. In 2007, we published our first study on measuring bias in CME, demonstrating that our assessment tool was valid and reliable. In light of the increasing interest in this area, and building on our experience, we wanted to further understand the application of this tool in different environments. We invited other CME/CPD providers from multiple sites in Canada to participate in a second CME bias study. METHODS: A new steering committee was established with representatives from 5 academic CME/CPD offices nationally, the Royal College of Physicians and Surgeons, and the College of Family Physicians of Canada to outline the project in terms of review of the literature, refining items on the tool, updating the training guide for implementation, and establishing a resource Web site for reviewers. Training involved a train-the-trainer session with the event coordinators at each of the 5 participating centers via videoconferencing. RESULTS: The content reviews from the study showed moderate inter-rater reliability (ICC = 0.54), and the live reviews showed poor overall inter-rater reliability; however, one center achieved substantial inter-rater reliability (ICC = 0.68). DISCUSSION: The analysis from this study suggests that the tool can be used as a part of a multistage process to introduce quality control mechanisms to help raise standards for CME/CPD. It is imperative to develop a cost-effective standardized training protocol that can be implemented at all sites to maximize the reliability of the tool.