Background and Origins
PAACT is a network of concerned health professionals who are committed to improving the health of Ontarians, in particular through the better use of prescription drugs. Our core founding members are physicians and pharmacists but we have grown over time to encompass other primary care providers and to partner with other groups to deliver programs.
We have been involved with efforts to improve drug use in Ontario for over a decade; including a number of large provincial trials with the goal of delivering balanced information to primary care providers.1,2,3,4 We have carried out 5 academic detailing trials , that has allowed us to refine both the material content and program delivery mechanisms for transmitting balanced information to the frontline. PAACT provides academic detailing services for the Department of Continuing Medical Education (CME), Faculty of Medicine, University of Toronto.
Our members were instrumental in the development of the internationally acclaimed Anti-infective guidelines. Since our early work we have employed the same rigorous approach to developing guidelines and educational programs in other areas. The PAACT method incorporates guideline development, criteria based DUR and a community-based adaptation of “academic detailing” within the framework of a network of practitioners who are continuously involved in efforts to evaluate the care we give to our patients, and identifying ways to make improvements to that care.
Academic Detailing Trials Summary (5 Trials)
A) 1994 - Academic Detailing to optimize the use of GI drugs. Funding: Drug Reform Secretariat, Ontario MOH.
Focus/Design:Specialists and primary care physicians in South Western Ontario; pilot study of 6 communities; emphasis on qualitative feedback from participants on materials and program design.
Reference: Dunn, LA. and Pilla NJ. Development and evaluation of a community based educational outreach program on H2 antagonists. Report submitted to the Centre for the Evaluation of Medicine, Hamilton and the Ontario Ministry of Health. 1994.
B) 1995/96 – Infectious Disease and Hypertension; RCT 3 arms (academic detailing vs. small group vs. control) Funding: Ontario MOH grant to Dept. of CME, University of Toronto
Focus/Design: 12 intervention sites and 6 control; 6 communities in Southern Ontario received academic detailing while the other six were offered a small group learning program, for each community 20 random family physicians names (total sample n=240) were generated using local hospitals as the unit of randomization. Core materials were the same for both programs and were based on the orange books (Anti-infective Guidelines and the Guidelines for Uncomplicated Hypertentsion.)
C) 1997 – Academic detailing in combination with DUR- Post-MI. Funding: Dept. of Family and Community Medicine, Medicine, University of Toronto; multi-site, Ontario.
Focus/Design: Academic detailing successful but DUR plagued by administrative and time constraints. The quality and credibility of materials is critical; must be peer-reviewed. Concept of an independent medical consultant well-received by family physicians.
D) 1998/99- RCT of academic detailing vs. industry detailing vs. control using same materials for education on COPD (Chronic Obstructive Pulmonary Disorder)
Funding: combined industry and government grant.
Materials used by both groups were designed by the COPD guideline development review panel. Academic detailers were local retail pharmacists who were provided with up-graded training and materials and PharmDs. Evaluation was qualitative and retrospective DUR using ODB data.
Reference: Implementation of Guidelines for the Treatment of Chronic Obstructive Pulmonary disease (COPD): A Comparison of Academic Detailing vs. Industry Detailing vs. Control. Dunn LA, Rosser WW, Bradley C, Pilla J. American Thoracic Society 96th International Conference, Toronto, May 5-10, 2000
E) 2000 - Academic Detailing Multi-site, cross Canada: Anxiety/Sleep disorder Health Transition Fund
Focus/Design: pharmacists as academic detailers follow-up to prescriber feedback from central mail-out. Focus on Benzodiazepines.
1. Stewart J, Pilla J, and Dunn L (2000). Pilot study for appropriate anti-infective community therapy: Effect of a guideline-based strategy to optimize use of antibiotics. Can Fam Phys., 46:851-859.
2. Rosser WW, Dunn LA, Pilla NJ. A Gap Too Wide: Transferring Evidence into Practice for the Benefit of the Population. 28th Annual Meeting of the North American Primary Care Research group (NAPCRG), Florida, Nov. 4-7th, 2000.
3. Dunn LA, Stewart JI, Meuser J, Pilla NJ, Rosser WW. Development of a Primary Care Guideline Implementation Network: The PAACT Project. College of Family Physicians of Canada, Family Medicine Forum, Ottawa, Oct. 18-22nd, 2000.
4. Rosser WW, Evans M, Pilla J, Dunn L. Moving towards Optimal Prescribing in Ontario. 27th Annual Meeting of the North American Primary Care Research Group (NAPCRG), San Diego, 1999.