Providers and supporters of continuing medical education (CME) “have gotten the message” and are delivering content without commercial bias, says John Kamp, executive director of the Coalition for Healthcare Communication.
A new video titled, “Conflict of Interest: The Bottom Line,” produced by CME Peer Review, features Kamp and other CME experts and providers discussing ways to minimize conflicts of interest in CME. “If someone has a conflict on something they’re speaking about, they disclose it,” Kamp said. “And we make sure, as much as possible, using peer review and other ways, that it’s not a biased review or use or suggestion on those drugs.”
The video emphasized how the CME environment has undergone significant transformation over the past 5-7 years. Participants maintained how CME providers and manufacturers who offer commercial support are following the rules. This has led to improved quality of CME programs, content and outcomes, which has improved patient care.
Many noted how there continues to be misperceptions about commercial support of CME, but that these instances happened prior to the ACCME Standards for Commercial Support and new system of accreditation.
The presentation defined “Conflict of interest” (COI) as “individuals who have both a financial relationship and the opportunity to affect the content.” Participants noted that managing COI is the most difficult and challenging task that CME providers face, especially given that 84% of physicians in 2010 reported some relationship with the pharmaceutical industry (Archives of Internal Medicine).
To address COI, participants recognized that CME providers must focus on quality and credibility. In fact, the rate of non-compliance for disclosures for CME providers was down to 38% in 2011and the rate of non-compliance for Resolution of COI was down to 39% in 2011 according to the ACCME annual report.
While disclosure is the first step to address COI’s, participants noted how CME providers also look at the level of relationship and commercial interest the faculty or content developers have. Today, CME providers not only disclose these interests but manage them to ensure CME quality remains very high.
One difficulty that everyone pointed to is the lack of CME industry standards for resolving COI’s. There is no definition for what constitutes “resolution” of a COI. Instead, it is up to each CME provider to determine. Accordingly, the participants discussed some of the methods they use in their CME companies to manage COIs.
For example, many emphasized the use of an external monitoring program to help validate that a company is managing COI’s in an appropriate fashion. This was clearly demonstrated by the fact that 96% of commercial supporters monitor supported activities (PACME 2011). Although ACCME does not dictate how to resolve COI’s, they do recommend in the Standards for Commercial Support, that CME providers have measures in place to guarantee independence of measures, content, and mitigate financial interests. ACCME clarified, however, that it does not recommend methods for COI resolution in the SCS.
ACCME offers resources concerning conflict of interest, with suggested mechanisms for resolving conflict of interest and examples that providers use, including peer review. These resources explain that ACCME does not prescribe methods for resolving conflicts of interest. The resources are available on ACCME’s Web site.
CME providers have three main responsibilities when it comes to COIs to truly ensure that content is independent, unbiased and of the highest quality:
1) Identify COIs;
2) Resolve COIs; and
3) Disclose COIs
In resolving a COI, providers can use peer review to ensure that the content and educational materials are unbiased and that they do not suggest treatments or products of which the faculty or content developer have an interest in. ACCME, however, does not require peer review. The content must not focus on one product but rather, it must speak to all treatments and options in as an unbiased way as possible.
Peer review ensures the quality of the CME and makes sure that content meets the very highest standards because CME that is objective, scientifically rigorous, and free of commercial bias allows clinicians to incorporate the education into clinical decisions based solely upon their patients’ needs and their experience.
When deciding who can provide peer review for CME providers, the presentation noted that companies must look for experts in field. Peer review must be external and certified as independent, with no COI’s or bias. The “peers” must be people who have gone through rigorous education that is the same as the content creator (faculty). The reviewer must have be vested in the medical community and understand the content that is being developed.
The presentation noted that, “a peer is an individual possessing and willing to share with others who have comparable education, expertise, experience, common interests, needs and aspirations.” A peer reviewer should be from the similar profession/sub profession and should be an expert in the same physician practice area or specialty. Ensuring this level of expertise and experience gives providers a feeling of comfort that they are being compliant.
For the presenter, peer review provides feedback and insights from a peer: someone who has similar levels of expertise and experience that cannot be obtained by any other means.
Conclusion
The presentation noted that the best way to answer concerns about bias in CME or from commercial support is to demonstrate independence by showing that the content of the activity has not been developed solely by faculty/authors, but that it has gone through rigorous and independent peer review. Moreover, providers should emphasize that only individuals with no commercial influence or relationships has reviewed content, and that these reviewers are at same educational and expertise level as the authors of the content, and that they understands the science, and can validate that the science is unbiased and free from influence.
Ultimately, peer review has raised the bar for the quality of CME content to ensure that it is applicable to every day practice, and focused on improving patient outcomes. Independent peer review, by a non-conflicted expert in field is the best way to resolve COI.
Accordingly, the participants emphasized the importance of CME providers starting to demonstrate the value of activities they develop. They emphasized that CME providers should continue using peer review and creating high quality CME programs based on learner needs. These programs should be developed and implemented to help health care providers improve the care they provide patients.
Ultimately, Kamp noted that CME is the solution to many problems in our health care system because CME can help improve the delivery of efficient and effective healthcare to patients.