Effect of Live, Case-Based, Multiformat, Interactive Physician Education on Diagnostic and Treatment Choices for Chronic Obstructive Pulmonary Disease (COPD) Care in the Primary Care Setting

Abstract

PURPOSE: Chronic obstructive pulmonary disease (COPD) is underrecognized and undertreated in the primary care setting. More studies are needed to assess the effectiveness of continuing medical education (CME) on improving physician competency and performance toward evidence-based care. METHODS: Between 9/26/09 and 12/12/09, 769 primary care physicians (PCP) participated in a series of 12 regional, live, interactive, case-based, multi-format, half-day CME programs on COPD. A subgroup of participants (n=50) and demographically matched non-participants (n=50) completed surveys that included detailed case vignettes, a validated tool for measuring physician performance in clinical practice. Case vignettes were designed to assess the consistency of diagnostic and therapeutic choices with clinical evidence. Effect size was calculated using Cohen's d to determine the magnitude of difference between participants and non-participants in the delivery of evidence-based care. RESULTS: Physicians who participated in CME programs were 50% more likely to provide evidence-based COPD care than those who did not participate. Furthermore, compared with nonparticipants, participants were more likely to correctly recognize COPD in a patient presenting with dyspnea (74% vs 94%; p=0.007), recognize that women may have a greater susceptibility than men to the toxic effects of smoking (54% vs 90%; p<0.001), and identify the mechanisms of action of emerging therapies (33% vs 65%; p=0.003). Participants were also twice as likely as non-participants to report complete familiarity with the GOLD guidelines for managing COPD (28% vs 14%), and less likely to cite difficulty in obtaining spirometry results as a barrier to optimal COPD care (25% vs 40%). CONCLUSION: According to validated measurements of efficacy of CME on physician competency and performance, PCPs who participated in a half-day regional CME program on COPD diagnosis, staging, and treatment were significantly more likely than nonparticipants to deliver evidence-based COPD care. CLINICAL IMPLICATIONS: With focused educational interventions, PCPs can make diagnostic and therapeutic choices that align more closely with current guidelines and clinical evidence in COPD management. was funded by an unrestricted educational grant from Novartis.; No Product/Research Disclosure Information.