title: Key Features of Academic Detailing: Development of an Expert Consensus Using the Delphi Method.
abstract: BACKGROUND
  Academic detailing is an outreach education technique that combines the direct social marketing traditionally used by pharmaceutical representatives with unbiased content summarizing the best evidence for a given clinical issue. Academic detailing is conducted with clinicians to encourage evidence-based practice in order to improve the quality of care and patient outcomes. The adoption of academic detailing has increased substantially since the original studies in the 1980s. However, the lack of standard agreement on its implementation makes the evaluation of academic detailing outcomes challenging.
  
  
  OBJECTIVE
  To identify consensus on the key elements of academic detailing among a group of experts with varying experiences in academic detailing.
  
  
  METHODS
  This study is based on an online survey of 20 experts with experience in academic detailing. We used the Delphi process, an iterative and systematic method of developing consensus within a group. We conducted 3 rounds of online surveys, which addressed 72 individual items derived from a previous literature review of 5 features of academic detailing, including (1) content, (2) communication process, (3) clinicians targeted, (4) change agents delivering intervention, and (5) context for intervention. Nonrespondents were removed from later rounds of the surveys. For most questions, a 4-point ordinal scale was used for responses. We defined consensus agreement as 70% of respondents for a single rating category or 80% for dichotomized ratings.
  
  
  RESULTS
  The overall survey response rate was 95% (54 of 57 surveys) and nearly 92% consensus agreement on the survey items (66 of 72 items) by the end of the Delphi exercise. The experts' responses suggested that (1) focused clinician education offering support for clinical decision-making is a key component of academic detailing, (2) detailing messages need to be tailored and provide feasible strategies and solutions to challenging cases, and (3) academic detailers need to develop specific skill sets required to overcome barriers to changing clinician behavior.
  
  
  CONCLUSIONS
  Consensus derived from this Delphi exercise can serve as a useful template of general principles in academic detailing initiatives and evaluation. The study findings are limited by the lack of standard definitions of certain terms used in the Delphi process.
authors.affiliation: Research Fellow, Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and a Clinical Fellow, Harvard Medical School, Boston, MA.
authors.forename: James S
authors.initials: JS
authors.lastname: Yeh
authors.affiliation: Associate Professor, University of Connecticut School of Nursing, Storrs, CT, and Associate Professor, Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Van Hoof
authors.affiliation: Director, National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, and Associate Professor, Harvard Medical School, Boston, MA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
keywords: Delphi method; academic detailing; clinician behavior; educational outreach; expert consensus; health professions education