Implementation of clinical guidelines in Brazil : should academic detailing be used?

de Oliveira Costa, Juliana and Almeida-Brasil, Celline Cardoso and Godman, Brian and Fischer, Michael Adam and Dartnell, Jonathan and Heaney, Aine and Bernardes dos Santos, Carolina Greco and de Assis Acurcio, Francisco and Álvares, Juliana and Guerra Jr, Augusto Afonso (2016) Implementation of clinical guidelines in Brazil : should academic detailing be used? Journal of Pharmaceutical Health Services Research, 7 (2). pp. 105-115. ISSN 1759-8893 (

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Objective: The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this paper are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently use the findings to develop and conduct a pilot Academic Detailing Program in Brazil targeting specialists who prescribe medicines for patients with Alzheimer’s disease, which are part of the Specialized Component of Pharmaceutical Assistance. Methods: Review international experiences and scientific publications relating to academic detailing based on a thorough review of available literature including publications known to the co-authors. Develop and monitor physician acceptance of academic detailing for patients with Alzheimer’s Disease and the impact on future prescribing. Key findings: Based on the lessons learnt from the international experience and review, coupled with the initial experiences in Brazil, we conclude that conducting academic detailing to enhance the implementation and dissemination of clinical protocols and therapeutic guidelines in Brazil is worthwhile. We will be closely monitoring the outcome of the pilot academic detailing programme as a basis for developing future programmes to further improve the quality of prescribing in Brazil. Conclusion: Findings from the experiences are encouraging. This will be further explored to provide a basis for this approach in the future.