The ISPE symposium on "Changing Behaviors: How do we do it? How do we know when we’ve done it?" was held in Baltimore, April 19, 2004. There were over 140 attendees.

Dr. Jerry Avorn, FISPE, of Harvard’s lecture on behavior change at the system and provider levels was the run-away hit of the day. As one attendee reported, Jerry’s talk was "superb, thoughtful, applicable, and stimulating." We were introduced to the new acronym "WWaDCD" — short for "What Would a Drug Company Do." Dr. Avorn was quoted as saying, "If you want to change physician behaviors, send an affable, well-dressed person to the MD’s office with lunch." And thus, academic detailing was born.

The keynote speaker was Dr. Baruch Fischhoff of Carnegie Mellon who introduced us to the theoretical basis of research in the fields of risk communication and health behavior change. He observed that the package insert for Rhinocort is in 3 point font with the exception of a larger, boxed warning that the chlorofluorocarbons contained herein will destroy the ozone layer, lead to global warming and eventually end all life as we know it. An item of more immediate concern regarding the risk of epistaxis is thoroughly obscured despite the fact that spontaneous nosebleeds may constitute a life-threatening condition in nerdy 12-year old boys, as Dr. Fischhoff noted. Clearly there is plenty of room for improvement in the field of risk communication.

Dr. Sean Hennessy, FISPE, of University of Pennsylvania was charged with the challenging task of providing the North American perspective on strategies to improve medication use. The disappointing news was that many of the interventions designed to improve medication use appear to have had little effect on utilization and clinical outcomes in the States.

Frank May, FIPSE, came to us from 'down-under' to share the Australian experience with changing prescribing behaviors. Although the Audit and Feedback Program didn’t appear to effect prescribing, the Drug and Therapeutics Information Service (DATIS), an academic detailing program, was effective and well-received by ‘wild-type’ general practitioners in Australia.

Dr. Debra Roter of the Johns Hopkins shared her experience with improving communication between doctors and patients using an interactive CD which includes videotaped sessions between the physician and a simulated hypertensive patient. Dr. Anne Trontell of FDA spoke about the agency’s interest in medication use behaviors and Dr. Ulf Bergman, FISPE, from the Karolinska Institute and Karolinska University Hospital — Huddinge introduced Stockholm’s Wise List of cost-effective medications.

[Editor's Note: Slides from the symposium presentations are posted in the Member Only section of the ISPE website.]

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