Table 1 Features and methods of academic detailing for mental health initiatives program

Identify leadership partners and establish buy-in: Meeting were requested and conducted with key clinical and pharmacy leadership to explain the goals and methods of the initiative, as well as address concerns and high-level barriers

Identify clinical staff with a high volume of patients with AUD in both primary care and mental health/addiction specialty care: using administrative data, the program identified staff with large numbers of AUD patients

Request detailing encounters with these priority providers, citing the previously established leadership support and enthusiasm

Build relationships with priority providers, engaging them in discussions about evidence-based medications and other practices (e.g., brief intervention for risky drinking): the goal was repeated visits to establish rapport and perceived value by the clinicians who received the resources and services

Explore barriers to prescribing the medications and applying the practices

 Examine and address knowledge and beliefs about the supporting evidence

 Address knowledge and misunderstandings about policies and scope of competence (e.g., belief that policy prohibits primary care clinicians from prescribing naltrexone or other AUD medications)

 Identify and problem-solve structural or logistical barriers (e.g., local policy or practice, staffing medication management visits.)

Introduce the providers to additional resources and tools including patient education tools, and pocket cards with FAQs

Introduce real-time, electronic medical record-integrated audit and feedback tools to identify actionable patients

Seek a commitment from the clinician to try to increase prescribing of the medications

Monitor progress and check back periodically for additional education, barrier identification, problem solving, and feedback. Monitor clinical targets (e.g., the number of patients receiving medications for AUD) and clinician use of the informatics tools, especially the case-finding dashboards. If the targeted prescribing behavior was unaffected, the next detailing session would again explore barriers, problem solve, and motivate clinicians