摘要：Objectives. We evaluated the effectiveness of the Public Health Detailing Program in helping primary care providers and their staff to improve patient care on public health challenges. Methods. We analyzed reported changes in clinical practice or behavior by examining providers’ retention and implementation of recommendations for campaigns. Results. During each campaign, 170 to 443 providers and 136 to 221 sites were reached. Among assessed providers who indicated changes in their practice behavior, the following statistically significant increases occurred from baseline to follow-up. Reported screening for clinical preventive services increased, including routinely screening for intimate partner violence (14%–42%). Clinical management increased, such as prescribing longer-lasting supplies of medicine (29%–42%). Lifestyle modification and behavior change, such as recommending increased physical activity to patients with high cholesterol levels, rose from 52% to 73%. Self-management goal setting with patients increased, such as using a clinical checkbook to track hemoglobin A1c goals (28% to 43%). Conclusions. Data suggest that public health detailing can be effective for linking public health agencies and their recommendations to providers and influencing reported changes in clinical practice behavior. The Public Health Detailing Program within the New York City Department of Health and Mental Hygiene (DOHMH) has worked closely with primary care providers and their staff since 2003 to improve patient care by addressing the leading, largely preventable, causes of illness, disability, and death. Drawing on evidence indicating that gaps in provider knowledge and the absence of office systems contribute to suboptimal care, the Public Health Detailing Program was designed to address these and other issues of care delivery. 1 Public health detailing focuses on neighborhoods facing the greatest health disparities and is part of New York City’s approach to reduce the disproportionate burden of poor health. Public health detailing initiatives center on clinical topics chosen for their anticipated effect on morbidity and mortality and other public health priorities. Although the focus is on managing chronic conditions, the program has “detailed” issues ranging from intimate partner violence screening to recruitment for the New York City Medical Reserve Corps, promoting the implementation and use of electronic health records, supporting exclusive breastfeeding, and improving medication adherence in patients with cardiovascular disease and diabetes. Public health detailing develops its campaigns in collaboration with internal and external clinical experts. The program strives to improve primary care physician practice through 1-on-1 visits, or “detailing,” a well-known and successful strategy usually associated with the pharmaceutical industry. 2,3 Whereas most public health interventions in the primary care setting focus on 1 condition or disease over time, public health detailing has developed a standard methodology for the delivery of a variety of public health messages. Highly trained Health Department representatives promote evidence-based, clinical preventive services and chronic disease management by delivering brief, targeted messages to the entire clinical care team of physicians, physician assistants, nurse practitioners, nurses, administrators, and other staff. 2,4 Through its campaigns, public health detailing supports providers and their staff by (1) outlining and discussing evidence-based key recommendations tailored to specific clinical interventions, (2) providing information on new public health policies or practice guidelines, and (3) assessing readiness to adopt key recommendations and supporting clinical tools that best suit the practice. 3 The Public Health Detailing Program’s “Action Kits” contain clinical tools, provider resources, and patient education materials to promote evidence-based best-practices recommended by the DOHMH, which are the focus of discussion during office visits by representatives. We have outlined the results of evaluations from 20 different campaigns.
