Pharmacists Provide Academic Detailing to South Carolina Health Care Providers

[December 15, 2008, AJHP News]

Greg Lavine

State laws prohibit the creation of preferred drug lists in these treatment areas, so public health leaders decided to test an academic detailing program to help guide prescribing, said Jeff Stensland, a spokesperson for the South Carolina Department of Health and Human Services.

The South Carolina Offering Prescribing Excellence (SCORxE) program sends clinical pharmacists to visit health care providers participating in the state’s Medicaid program.

SCORxE pharmacists, unlike pharmaceutical company representatives, are not looking to make a sale, said Sarah Ball, of the South Carolina College of Pharmacy, who heads the academic detailing program.

“We don’t have anything to sell, other than knowledge,” she said.

Instead of a traditional sales pitch, SCORxE’s academic detailing consultants offer the latest research, best practices, and balanced information on mental health treatments initially. As the program grows, cancer and AIDS treatment information will be added, Ball explained.

“What [Medicaid officials] saw was the drug budget going up in this area,” she said of mental health, “but didn’t feel like they saw a corresponding improvement in quality of care.”

In October 2007, the program launched its first academic detailing topic of schizophrenia. In March, major depressive disorder was added as a second consultation topic, Ball said.

For the South Carolina Medicaid program, 25% of prescription medication spending went to mental health drugs alone. Four of the top five prescribed drugs from the state’s Medicaid program are for mental health, Stensland said.  

In some cases, research has shown that older mental health drugs perform as well or better than the latest generation of treatments. SCORxE’s first focus has been on atypical antipsychotic drugs, Stensland explained.

“Our concern wasn’t just that we hold down cost but it was also we wanted to ensure that folks were prescribing these drugs in the correct manner,” he said.

The Medicaid program has partnered with the South Carolina College of Pharmacy through a five-year grant signed in September 2006. The initial grant was for two years at $1.98 million, with annual renewal options for another three years.

Ball came to the South Carolina College of Pharmacy to oversee the SCORxE program in February 2007. The state has already opted to give SCORxE the first annual renewal, which will pay for services through the end of 2009.

“Given the economic times, I considered that a true vote of confidence of what we’ve done to date,” she said.

An advisory board, which includes pharmacists, physicians, and other health care professionals, guides the program.

Program leaders picked 6 counties, a mix of urban and rural, to begin testing the program. Out of South Carolina’s 46 counties, the 6 chosen are home to about a third of the state’s Medicaid population, she said.

While program organizers could have picked cancer or AIDS treatments, the experts settled on starting with mental health. Ball said SCORxE created a mental health panel to determine what messages should be delivered.

Data from the Texas Medication Algorithm project, which uses expert consensus and scientific evidence to create treatment strategy guidelines, served as a basis to help psychiatrists and physicians participating in South Carolina’s Medicaid program. The mental health panel created best practice reports that are shared with participating health care providers.

SCORxE has a budget for up to four full-time-equivalent (FTE) positions and now has two full-time and two part-time clinical pharmacists who live in the regions they serve. Each FTE consultant will aim to work with about 150 health care providers.

“The clinical consultants are the foundation, [and they] are actually building the personal relationships with physicians throughout the state,” Ball said.

Originally, program leaders expected consultants might have 5–10 minutes for a physician visit, but typical encounters have averaged around 25 minutes, she said.

The first visit introduces the program and allows the consultant to start building a relationship with the health care provider, she said. Plans call for one or two topics to be covered each year. Consultants are aiming to make four visits to each provider annually to follow up with questions or concerns.

SCORxE’s organizers are now determining which counties to add for 2009, when the new academic detailing topic of bipolar depression will be added. Organizers are still trying to determine what impact the program has had so far, she said.

“Something like this is probably going to take a couple of years before you’re going to see anything substantial,” Stensland said of the program’s cost savings.