About KUPP

KUPP contributes to rational use of medicines, by improving the quality of prescribing in primary care.

KUPP – The Norwegian Academic Detailing Program is the Norwegian version of Academic detailing, aimed at physicians working in general practice . In academic detailing, trained pharmacists and physicians (clinical facilitators) visit general practitioners (GPs) one-to-one in the physicians office. This visit has a duration of 20 minutes, and covers the most important subjects regarding use of medicines in a specific therapeutic area.

Background
The idea of academic detailing was developed by Jerry Avorn, who published the first scientific paper on the subject in New England Journal of Medicine in 1983. Jerry Avorn is now a professor at Harvard Medical School in Boston, and has been working with academic detailing his whole career..

Avorns idea was to use the same principles that the pharmaceutical industry used to sell its products, but instead of selling products, he wanted to give an independent, evidence-based update on recommended treatment to prescribers.

Academic detailing and KUPP are tools that will contribute to rational prescribing of medicines. KUPP startet our service in Norway on a small scale in 2015, highly influenced by the work of Avorn and colleagues in Boston, and by the academid detailing service provided by National Prescribing Service (NPS) in Australia. Since 2015, KUPP has completed four campaigns. The fifth campaign, Better use of hormons during and after menopause, will be launched in september 2020.

How do we do it?
When preparing a new KUPP-campaign, a group of professionals (physicians and pharmacists) review relevant and updated literature in a specific therapeutic area, and disseminate this. Key messages with practical advice for prescribers are developed. This information is then collected in a four-page brochure. The brochure is used in the meeting between the prescriber and the clinical facilitator.

Dialogue is crucial in these meetings, and the one-to-one setting gives a unique possibility to adopt the meeting to every single prescribers needs and previous knowledge. This is the biggest difference between academic detailing and regular group meetings.

We offer our service to GPs, and have defined the duration to 20 minutes to fit with the most common time slots for patient consultations in Norwegian general practice. When visiting GPs, we ask them to give us time corresponding to the consultation time for one patient. In that way the physician can have an independent, evidence based update without leaving office, and with minimal use of time.

Organizing and financing
KUPP – The Norwegian Academic Detailing Program is run as joint venture between the Regional Drug Information and Pharmacovigilance Centres (RELIS) and the Clinical Pharmacological departments at the four university hospitals in Norway: St. Olavs Hospital (Trondheim), Haukeland University Hospital (Bergen), University Hospital of North-Norway (Tromsø) and Oslo University Hospital. The administrative center for KUPP is located at RELIS/Dept. for Clinical Pharmacology at St. Olavs Hospital in Trondheim.

KUPP is financed by an unconditional grant from the Ministry of Health and Care Services (HOD) . KUPP is independent from pharmaceutical industry, and we decide both the theme for our campaigns and the content of our campaigns independent from governmental and funding organisations.

The visits are conducted by pharmacists and physicians employed at RELIS or the Clinical Pharmacological departments. All visitors have been trained in academic detailing, and also receive specific training for each campaign.

To ensure user involvement  we have a member on the board for KUPP from The Norwegian Association of General Practitioners (NFA), and general practitioners are always involved in the development of campaigns and campaign materials.

Evaluation and documentation
By the summer of 2020 we have done about 4500 KUPP-visits with Norwegian GPs all over the country over four different campaigns. All participating GPs are invited to evaluate the visit via an electronic questionaire . The respons rate has been between 55-74% for the different campaigns.

The evaluations have been very positive. 98% of respondents rates KUPP as a suitable method for producer-independent, evidence-based information. When asked if it they are likely to accept a second visit on a different topic, 80-90% have responded “very likely” and 10-20% “likely”. Only 1% have responded “unlikely” or “I don’t know”.

After our first campaign, Better use of NSAIDs, we saw a reduced prescribing of diclofenac of 16% and 18% in the intervention cities compared to the rest of Norway (who did not receive visits, and served av control group). Results has been published in European Journal of Clinical Pharmacology, and is available via open acces here. At this time we also have several active studies to evaluate the effectiveness of KUPP, and we are expecting to publish our next paper during 2021.

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