What is SCORxE?

The South Carolina Medicaid Academic Detailing Program is officially identified as SCORxE which stands for South Carolina Offering Prescribing Excellence. Our mission is to improve the quality of care for South Carolina Medicaid patients in the most cost effective manner by promoting quality, evidence-based drug therapy and best practices through face-to-face communication with providers.

Why academic detailing?

The pharmaceutical industry has long used detailing to promote drug products to the medical community. Academic detailing utilizes the effective communications strategies of the pharmaceutical industry, but is not limited to any one type of product. Clinical consultants meet face-to-face with providers to offer them unbiased, evidence-based clinical information about drug therapy and best-practices that will assist with making best prescription decisions. Academic detailing programs have been used successfully in other countries, including Australia and Canada. In the United States, Pennsylvania has an active program sponsored by the PACE Program of the Pennsylvania Department of Aging.

Who supports SCORxE?

This program, the first of its kind in the state, is a collaborative effort between the South Carolina College of Pharmacy (SCCP) and the South Carolina Department of Health and Human Services (SCDHHS). SCDHSS provided $1.98 million to the College to provide academic detailing services to physicians who serve Medicaid patients with mental health disorders, HIV/AIDs or cancer.​

Clinical Topics

2013

Second Generation Antipsychotics (SGAs) in Pediatrics

  • Complete a mental health evaluation, including assessment for substance abuse, prior to initiating an antipsychotic or any other psychotropic medication.
  • Assess the effectiveness of and continued need for antipsychotics on a regular basis.
  • Routinely monitor for weight gain, metabolic changes and other antipsychotic medication side effects.
  • Engage with family, child and other key people (e.g., other healthcare professionals, teachers, caregivers) involved with child.

8-page handout - March 2013 (pdf)

Healthy Sleep Habits - February 2013 (pdf)

2012

Treatment of Asthma in Pediatrics

  • Assess and document initial severity and follow-up control to select optimal medications.
  • Environmental control includes a smoke-free home and car and avoiding or minimizing exposure to triggers.
  • Develop a written asthma action plan for patient self-management and provide copies for use at home, school and daycare.
  • Instruct patients and parents on the proper use of each of their inhalers

8-page handout – March 2012 (pdf)

8-page handout reference page– March 2012 (pdf)

2011

Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Pediatrics

  • Assess input from both home and school before diagnosing ADHD in children and adolescents.
  • Discuss strengths/weaknesses of pharmacotherapy and behavioral therapy while considering comorbidities to individualize treatment plan.
  • Have functional and symptomatic improvements included in negotiated treatment goals with parents and teachers.
  • Do monthly follow-up in early phases of care for each new ADHD patient or new ADHD medication. 

8-page handout – April 2011 (pdf)

20-page summary – April 2011 (pdf)

Everyday Survival Tips and Behavioral Strategies - March 2012 (pdf)

2010

Promotion of Smoking Cessation

  • Question and document tobacco use at every visit.
  • Understand the challenge to quit and expect relapse.
  • Identify readiness to quit to best tailor approach to patient.
  • Treatment is effective and multiple options allow for individualized interventions.

8-page handout - October 2010 (pdf)

16-page summary - October 2010 (pdf)

S.C. Tobacco Quitline Fax Referral Form - October 2010 (pdf)

U.S. Department of Health and Human Services – You Can Quit Smoking (English) – September 2008 (pdf)

U.S. Department of Health and Human Services – You Can Quit Smoking (Spanish) -September 2008 (pdf)

2009

Treatment for Bipolar Disorder

  • Accurate and timely diagnosis is critical to optimize clinical outcomes.
  • Return to full psychosocial functioning is the goal of treatment.
  • Medication is the mainstay of treatment for initial mood stabilization and maintenance.
  • Screen for substance abuse to increase the chance of clinical improvement.

8-page handout – March 2009 (archived)

16-page summary – March 2009 (archived)

Mood Disorder Questionnaire – March 2009 (pdf)

Mood Chart – March 2009 (pdf)

2008

Treatment of Non-psychotic Major Depressive Disorder

  • Adequate trial of an antidepressant consists of BOTH an adequate dose and duration
  • Rating scales, such as the Patient Health Questionnaire (PHQ-9), are useful to assess symptom severity before initiating medication and at regular intervals to assess patient response.
  • Treat to remission, not just partial response, and inform patients that remission is the goal of treatment.
  • Total duration of treatment should last 9-12 months for the first episode of depression, and potentially indefinitely for severe or recurrent episodes.

 

4-Page Handout - October 2007 (Archived)

12-Page Summary - October 2007 (Archived)

Rating Scale - October 2007 (pdf)

2007

Treatment of Schizophrenia

  • An adequate trial of an antipsychotic consists of BOTH an adequate medication dosage and duration.
  • Use a rating scale to assess symptom severity before initiating medication; then repeat scale at regular intervals to assess patient response and determine if further dose adjustments are needed.
  • Talk with the patient and family about the importance of medication adherence and collaborate to provide symptom relief and minimize side effects.

4-Page Handout - October 2007 (Archived)

12-Page Summary - October 2007 (Archived)

Rating Scale - October 2007 (pdf)

Evidence-Based Best Practices Reports

May 2012

Best Practices for the Management of Asthma in Pediatric Primary Care in South Carolina 

A group of pediatricians, including a pediatric pulmonologist, and clinical pharmacists was created to develop evidence-based content on the management of asthma in pediatric primary care. The National Institutes of Health National Asthma Education and Prevention Program Expert Panel Report-3 2007 was the group’s primary source of data.  Additional review of primary literature and clinical practice guidelines offered supplemental information, along with clinical consensus from the SCORxE writing group.  

SCORxE Writing Group (Sarah Ball, Pharm.D.,Mike Bowman, M.D., Sandra Garner, Pharm.D., Nancy Hahn, Pharm.D., Sophie Robert, Pharm.D., Francis Rushton, M.D.,Elizabeth Weed, Pharm.D., Sheila Woods, M.D.)

 

November 2010

Best Practices for the Promotion of Smoking Cessation in South Carolina 

A group of primary care physicians, pharmacists, and other healthcare professionals was created to develop an evidence-based best practices report to focus on promoting smoking cessation in primary care. The May 2008 Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. U.S. Department of Health and Human Services Public Health Service (hereby referred to as PHS Guideline) was the group's primary source of information. Most of the evidence is based on studies of cigarette smoking. In many cases, the PHS Guideline panel believes the results can be generalized to all tobacco users. This report includes additional recommendations from a review of primary literature published since the PHS Guideline was issued. Modifications were made to the PHS Guideline as necessary for the SCORxE project.

SCORxE Writing Group (Sarah Ball, Pharm.D., Leonard Egede, M.D., Nancy Hahn, Pharm.D. , Patrick Mauldin, Ph.D., William Moran, M.D., Jean Nappi, Pharm.D.,Sophie Robert, Pharm.D.)

December 2010

Primary Care Management of ADHD in Childhood – An Overview of the Literature

A comprehensive literature review was conducted to create an evidence-based report on the management of Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric primary care. The literature review and report utilized several clinical practice guidelines published in the United States and England from 2000 through 2009. The report also provides supplemental information from a number of important recent publications. The scope of the review was restricted to the management of ADHD in children and young adolescents.

Original Review (Frank May of the Australian Drug and Therapeutics Information Service) 
SCORxE Editors (Sarah Ball, Pharm.D., Sophie Robert, Pharm.D., Nancy Hahn, Pharm.D., Elizabeth Weed, Pharm.D.) 

 

Evidence-based Best Practices

A panel of psychiatrists and five clinical pharmacists from different geographic regions of the state was created to consensually agree on evidence-based best practices for the treatment of selected mental health disorders in South Carolina. The panel recommended detailed treatment algorithms as the core of their best practices. The evidenced-based materials and algorithms developed and implemented in the Texas Medication Algorithm Project (TMAP) were the panel’s primary source of information. Supplemental information included specific recommendations from a review of primary literature and clinical opinion of the SCORxE mental health panel members. Modifications were made (with permission) to the TMAP content and algorithms as necessary for the SCORxE project, based on the panel’s consensus or vote. Panel members listed below co-authored all three best practices reports unless otherwise indicated.


October 2007

Best Practices for the Treatment of Schizophenia in South Carolina (Archived)

February 2008

Best Practices for the Treatment of Major Depressive Disorder in South Carolina (Archived)

May 2009

Best Practices Report for the Treatment of Bipolar Disorder in South Carolina  (Archived)