Academic detailing: A model for in-office CME

The National Cancer Institute (NCI), in its goal to reduce cancer mortality by 50% by the year 2000, has placed a special emphasis on prevention and early detection, especially in undeserved populations. Check- Up On Health is a community based health education program being carried out by Fox Chase Cancer Center in three inner city Philadelphia neighborhoods, to improve the provision of appropriate cancer screening and prevention services to older, blue-collar adults by their primary care physicians. Primary care physicians in the chosen neighborhoods were targeted to receive a brief cancer prevention educational message delivered by project staff and patterned on the model of drug detailing developed by the pharmaceutical industry. This study represents an attempt to evaluate the feasibility and acceptability of such an approach aimed at improving cancer prevention promotion in the health care system. Primary care physicians were identified by community residents who attended one of 67 Check-Up On Health education presentations about cancer prevention at churches, social clubs, and senior- citizen centers within the targeted neighborhoods. An attempt was then made by project staff to visit each identified physician in his/her office or clinic, during office hours, both to conduct a brief survey and to deliver an educational message about either cancer screening guidelines or counseling for smoking cessation. The physicians were also provided with educational materials for themselves as well as their patients. Twelve months after the visit, a follow-up phone call to the physicians assessed the impact of the visit and solicited suggestions for future outreach efforts. Two hundred twenty-one (81%) of the physicians named by community residents were visited by Check-Up On Health staff. The physicians were able to share insights into barriers to cancer prevention activities, and almost all accepted the education materials offered. Twelve-month follow-up revealed a substantial increase in cancer screening and prevention activities, as well as an increased confidence in counseling skills expressed by the physicians. An academic detailing approach to providing primary care physicians with information and educational tools about health promotion is feasible and potentially effective in improving screening and prevention practices.