Physicians who participated in live half-day, case-based, multi-format Continuing Medical Education (CME) workshop were 50% more likely to provide evidence-based care for chronic obstructive pulmonary disease (COPD) than those who did not participate, according to a study conducted by the Potomac Center for Medical Education (PCME), a Rockpointe company, and CE Outcomes, LLC. These findings, which point to the positive impact of CME on physician practice, were published in the International Journal of COPD on May 25, 2011.
Previously, the positive outcomes from this CME program were presented at Chest 2010, the annual meeting of the American College of Chest Physicians, which was held October 30-November 4 in Vancouver, BC, Canada.
In addition to being more likely to provide evidence-based care, participants were more likely than non-participants to correctly recognize COPD in a patient presenting with dyspnea (94% vs 74%; P=0.007); recognize that women may have a greater susceptibility than men to the toxic effects of smoking (90% vs 54%; P<0.001); and identify the mechanisms of action of emerging therapies (65% vs 33%; P=0.003). Each of these areas had been identified as gaps in current COPD clinical practices; thus, these findings show that continuing medical education can help narrow these gaps.
The series of live symposia were CME-certified by accredited provider PCME and supported by an unrestricted educational grant from Novartis. Attendees listened to comprehensive presentations from nationally recognized faculty thought-leaders and participated in interactive hands-on workshops, where they conducted spirometry tests and treated “virtual” patients through case studies.
Background
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. Approximately 16 million Americans are currently diagnosed with COPD, while another 14 million may be affected but remain undiagnosed. Each year, COPD is responsible for more than eight million physician office and hospital outpatientvisits, 1.5 million emergency department visits, and 726,000 hospitalizations. COPD is the fourth leading cause of death in the US, and is projected to become third by the year 2020 if drastic changes in diagnosis and management are not implemented.
Despite these striking statistics, COPD remains poorly managed in the primary care setting. One major barrier to better patient outcomes is the underdiagnosis of COPD, which delays treatment and leaves symptoms unmanaged.
Consequently, a recent study published in the International Journal of COPD found that participants in a series of live, regional CME programs were 50% more likely than non-participants to provide evidence based care. The results from these CME programs were previously presented at the American College of Chest Physicians annual meeting Chest 2010 in Vancouver, British Columbia
COPD in the Primary Care Setting
COPD is highly prevalent in primary care; approximately one in four adults aged 40 years or older with known risk factors for COPD, including tobacco use and self-reported symptoms of chronic bronchitis, have airway obstruction consistent with a diagnosis of COPD. Yet primary care physicians will less commonly consider and pursue the diagnosis of COPD than other diagnoses with fewer symptoms, such as hypertension and diabetes. Moreover, only one in four primary care physicians adhere to guideline-recommended spirometry and medication use more than 90% of the time.
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, COPD is both a preventable and treatable disease, and increased focus on accurate diagnosis, staging, and management may reduce the overall burden of the disease. Continuing medical education (CME) programs that address the inadequacies of COPD care may improve physician competency in providing guideline directed
COPD care. The American College of Chest Physicians has called for more research on the effectiveness of CME initiatives in improving physician competency and performance toward evidence-based care.
The underlying rationale for CME is that providers who are educated about the latest standards of care will make more informed diagnostic and treatment decisions, resulting in improved patient outcomes. To date, the CME literature suggests that the most effective strategies contain several design elements, such as a rigorous and accurate assessment of need, use of active and varied learning approaches, and an evidence-based curriculum that focuses on overcoming barriers to change. Additionally, a change in physician practice is more likely with interventions that are multifaceted, interactive, and consistent with the perceived needs of the learner.
CME and COPD
Consequently, to address this gap in care and lack of awareness and knowledge surrounding COPD, the Potomac Center for Medical Education (PCME) held a series of 12 regional, live, half-day meetings between September and December 2009 entitled, “Improving COPD Patient Outcomes: Breaking Down the Barriers to Optimal Care.” These live regional meetings were supported through an educational grant from Novartis and targeted primary care practices, general practitioners, or primary care providers (PCPs). The goals of these programs, upon successful completion, were for primary care physicians to be able to:
- Describe the demographics of COPD burden and explain the impact of patient comorbid conditions on COPD outcomes and management
- Obtain reliable office spirometry results through proper patient education and coaching
- Diagnose, stage, and manage a patient with COPD with a combination of management strategies, including risk reduction and pharmacologic and nonpharmacologic interventions per guideline recommendations
- List emerging therapies for the management of COPD
- Implement patient-oriented strategies to optimize adherence and improve outcomes
769 health care providers participated in the educational program, including 699 physicians, 13 nurses, and 57 other practitioners. Participants reported seeing a total of at least 8459 patients with COPD per week within their clinical practices.
These programs were a mix of proven adult-learning formats, which included a series of short (25-30 min) didactic lectures and a video on the correct use of inhaler devices. The programs also used small-group workshops that went into detailed case discussions, where doctors treated “virtual patients,” and included hands-on demonstrations of the correct use of hand-held spirometers, along with active role-playing of spirometry coaching, reading and interpretation.
To measure whether these programs were successful in meeting these educational objectives and goals, PCME and CE Outcomes, LLC, surveyed a subgroup of participants (n=50) at the end of each program, and demographically matched non-participants (n=50). The survey 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. An assessment was then designed to determine:
- Whether the diagnostic and therapeutic choices of participants were consistent with the clinical evidence presented during the educational activity
- Whether practice choices of participants were different from practice choices of non-participants
- Barriers to the optimal management of COPD
One significant finding from the study showed that participants in the CME program were 50% more likely than non-participants to provide evidence based care. CME program participants were also more likely than non-participants to:
- Correctly recognize COPD in a patient presenting with dyspnea (94% vs 74%)
- Recognize that women may have a greater susceptibility than men to the toxic effects of smoking (90% vs 54%; P<0.001)
- Identify the mechanisms of action of emerging therapies (65% vs 33%; P=0.003)
- Report and demonstrate increased familiarity with the GOLD guidelines
- Correctly determine disease severity (58% vs 44%) based on FEV1
- Select a strategy for maintenance therapy
- Demonstrate a greater willingness to use office-based spirometry in initial assessment of suspected COPD (98% vs 90%) and long-term monitoring (86% vs 76%)
- Report a lower level of familiarity with spirometry measurements
Conclusion
Ultimately, clinicians who participated in this commercially supported CME program demonstrated improved knowledge and competency of the underlying pathophysiology of COPD and in a variety of areas related to the management of COPD, including etiology and risk factors, disease staging, guideline-directed patient management, and emerging treatment options. Moreover, specific areas of patient care that were most affected by attending the activity included recognizing gender differences in susceptibility to the toxic effects of smoking, using spirometry in the assessment and monitoring of patients with COPD, identifying stage of COPD based on the FEV value, and maintenance therapy.
These findings are significant because each of the areas that saw significant improvement from CME participation had been identified as gaps in current COPD clinical practices. As a result, these findings show that CME can help narrow these gaps.