Principles and uses of academic detailing to improve the management of psychiatric disorders.

OBJECTIVE: The purpose of this article is to discuss the principles of academic detailing, or educational outreach, in primary care and review the evidence of its effectiveness in, and potential for improving, mental health care.
METHODS: The general educational research literature on improving physician performance was reviewed along with studies that were designed to test academic detailing. Four rigorous studies have tested this approach specifically on mental health care. These studies are reviewed in detail.
RESULTS: Measuring pre-intervention performance to target those with increased educational needs and identifying barriers to change are associated with substantially improved program effectiveness. To change strongly held beliefs or to overcome patient demands, person-to-person contact with credible experts who provide structured alternatives is necessary. Brief reinforcement visits increase success rates and targeting programs to physicians at greatest need improves the cost effectiveness of educational interventions.
CONCLUSIONS: Academic detailing is one of the few educational interventions that has consistently demonstrated improved physician performance. Educational outreach methods to improve mental health practices in primary care are in need of much additional research. Improving the detection of mental disorders and underuse of mental health treatment may prove to be more difficult than reducing the overuse of unnecessary medications.