Effectiveness of an academic detailing service to support appropriate prescribing and care in patients with type 2 diabetes

Background — Academic detailing (AD), a one-on-one evidence-based educational outreach strategy for healthcare providers, has been effective in improving prescribing behavior. However, its impact on diabetes care outcomes in Canada remains underexplored.

Objective — We aimed to compare prescribing and care patterns for type 2 diabetes between physicians who received AD and those who did not.

Methods — We conducted a population-based matched cohort study in Ontario, Canada, using health administrative databases. We included primary care physicians with active billing from September 2020 to September 2022. Each AD physician was matched to a maximum four controls based on index year, region, sex, years in practice, and proportion of patients with diabetes. We assessed monthly clinical outcomes for 12 months pre and 18 months postintervention using mixed-effects models.

Results — The cohort included 372 AD and 1450 control physicians, with balanced demographics. At baseline, AD physicians saw fewer patients (1292 vs. 1526) but delivered more appointments per patient (4.2 vs. 3.0). Both groups had 15% of patients with diabetes. Post-intervention, biosimilar insulin use increased more sharply in the AD group (9.0% vs. 5.6% monthly). AD physicians consistently had higher B12 testing among metformin users (76.5% vs. 60.0%) and greater use of SGLT2 inhibitors or GLP-1 receptor agonists (40.1% vs. 31.5%). A1C control (<8%) remained similar across groups (∼80%). Time × group differences were significant for all outcomes (P < 0.001) except B12 testing (P = 0.790) and A1C levels (P = 0.815).

Conclusions — The AD group saw greater improvements in diabetes prescribing post-intervention. Engaging physicians in AD could enhance diabetes care quality.