Implementation of clinical guidelines in Brazil : should academic detailing be used?

Objective: The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this paper are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently use the findings to develop and conduct a pilot Academic Detailing Program in Brazil targeting specialists who prescribe medicines for patients with Alzheimer’s disease, which are part of the Specialized Component of Pharmaceutical Assistance. Methods: Review international experiences and scientific publications relating to academic detailing based on a thorough review of available literature including publications known to the co-authors. Develop and monitor physician acceptance of academic detailing for patients with Alzheimer’s Disease and the impact on future prescribing. Key findings: Based on the lessons learnt from the international experience and review, coupled with the initial experiences in Brazil, we conclude that conducting academic detailing to enhance the implementation and dissemination of clinical protocols and therapeutic guidelines in Brazil is worthwhile. We will be closely monitoring the outcome of the pilot academic detailing programme as a basis for developing future programmes to further improve the quality of prescribing in Brazil. Conclusion: Findings from the experiences are encouraging. This will be further explored to provide a basis for this approach in the future

An Exploratory Study to Improve Sales Operations When Selling Multiple Prescription Drugs

This paper explores the importance of integrating knowledge with quantitative modeling process to improve sales operations in multiple product selling situations in the pharmaceutical industry. A knowledge-based approach is proposed to minimize challenges in detailing multiple products to physicians who are more and more difficult accessing in recent years. The performance of this new approach is compared against the traditional approach via actual implementation by the firm that is sponsoring the research. Results based on three months of implementation indicate that the knowledge-based approach performs significantly better with increasing the number of responsive physicians by 71% and profit by 9%

Shared geriatric mental health care in a rural community

Introduction: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. Methods: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. Results: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. Conclusion: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated

Practical Strategies for Pharmacist Integration with Primary Care: A Workbook.

This workbook is a practical set of tips and resources to assist pharmacists in providing clinical pharmacy services to primary care providers and their patients. The content was written based on experiences in Vermont in 2014, however the topics should generalize to pharmacists in other areas

The impact of marketised discourse on the interaction between drug representatives and physicians

Drug representatives (‘drug reps’) visit physicians to present and promote pharmaceutical products (‘drug detailing’). Against the background of a continuous innovative slow-down, drug companies have shifted strategic emphasis towards marketing and selling. With regards to drug detailing, I am investigating how this shift towards marketing is manifested in discursive terms. I show how the detailing discourse is impacting the attitudes and behaviours of those involved in it, namely physicians, drug reps and their managers. By means of qualitative interviewing I access the individual meaning-making and attitudes towards the phenomenon of drug detailing. I demonstrate how discourse is designed, transformed and responded to. In that, I point to a system of incompatibility resulting in unproductive action. Marketised discourse as devised by management is not fostering collaboration between the industry and the medical profession. Moreover, it leads to a growing detachment of drug reps from their organisations. By highlighting the issue of drug detailing for the first time from a drug rep perspective my research demonstrates that the industry is not an integrated ideological whole. I conclude by advocating a more transparent conduct of business, suggesting controlling means to improve the quality of information delivery. Last not least I want to stimulate a critical public discourse about the sublime ways of constructing and disseminating marketised pharmaceutical information

USING DSS IN THE CLASSROOM

This research investigates the use of decision support systems while employing a classroom simulation game as a methodology. The goal of this paper is to find the unique patterns associated with the systems. Several techniques are employed to build the decision support model. The proposed model is applied in one MBA class and proved by the participants of the simulation experiments. Consequently, the model provides a feasible route to guide information technology specialists to establish effective and efficient decision support systems

Combining factual and heuristic knowledge in knowledge acquisition

A knowledge acquisition technique that combines heuristic and factual knowledge represented as two hierarchies is described. These ideas were applied to the construction of a knowledge acquisition interface to the Expert System Analyst (OPERA). The goal of OPERA is to improve the operations support of the computer network in the space shuttle launch processing system. The knowledge acquisition bottleneck lies in gathering knowledge from human experts and transferring it to OPERA. OPERA's knowledge acquisition problem is approached as a classification problem-solving task, combining this approach with the use of factual knowledge about the domain. The interface was implemented in a Symbolics workstation making heavy use of windows, pull-down menus, and other user-friendly devices