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Academic Detailing in Norway—Caring for GPS Where They Are

      Background

      The Department for Clinical Pharmacology and the Regional Medicines Information and Pharmacovigilance Center (RELIS), St. Olavs Hospital, Trondheim has for many years offered educational outreach services towards primary health care, continuously searching for methods that is proven to make lasting changes in GPs behavior.
      After reading literature on the method Academic Detaling, and visits to The National Prescribing Service (NPS) in Australia and NaRCAD in Boston we realized that we wanted to try Academic Detailing as a method for an educational outreach towards general practitioners in Norway.
      We received a grant from the Norwegian Health authorities, and conducted a pilot project in the cities of Trondheim and Tromsoe in the spring of 2015.

      Intervention and Details on Implementation

      Our first pilot was on Wiser use of NSAIDs, with focus on reducing the widespread use of diclofenac in Norway, due to the high risk of cardiovascular disease associated with diclofenac. If the GP found it necessary to use a NSAID we advised him/her to use naproxen eventually under cover of a PPI due to the lower risk of cardiovascular adverse events. 213 family doctors of 247 were given a 20 minute one-on-one visit during office hours with a brochure developed for the campaign.

      Evaluation Methods

      The pilot was evaluated through electronic questionnaires to all participating doctors and data from The Norwegian Prescription Database (NorPD) to evaluate changes in prescribing of NSAIDs. The main outcome was reduction in prescribing rate for diclofenac and eventually an increase in the use of naproxen.

      Results

      The general practitioners gave a very high rating, with 98,5 % of the doctors welcoming a new visit with another campaign. The prescribing of diclofenac was reduced in Tromsoe and Trondheim and there was an increase in the use of naproxen compared to other areas in Norway. The results of the intervention was even better one year after.
      Tabled 1
      Diclofenac (incl. Combinationes)
      April-June 2014April-June 2015Change 2014-2015April-June 2016Change 2014-2016
      Tromsø7,25,9–17,8 %5,5–23,8 %
      Bodø10,19,6–4,7 %8,9–11,9 %
      Trondheim8,85,8–34,4 %5,1–42,3 %
      Bergen9,89,3–5,3 %8,6–12,4 %
      Norway9,59,0–5,6 %8,5–10,9 %
      Tabled 1
      Naproxen (incl. Combinationes)
      April-June 2014April-June 2015Endring 2014-2015April-June 2016Endring 2014-2016
      Tromsø3,85,338,8 %5,955,1 %
      Bodø4,85,29,4 %6,433,6 %
      Trondheim4,78,376,8 %9,297,3 %
      Bergen3,64,012,0 %4,731,2 %
      Norway4,14,919,0 %5,739,6 %

      Conclusions/Lessons for Other Programs

      Academic Detailing gives clinicians effective producer independent knowledge based therapeutic updating where they are – in their own offices. This method should be used all over Europe.
      We are working to establish AD as a national service for all general practitioners in Norway.