Over the past year, a number of continuing medical education (CME) and continuing education (CE) programs have showed significant outcomes in improving physician skills, knowledge and competence, as well as patient outcomes. Specifically, CME programs have positively affected COPD, Hypertension, ICU patients, Sepsis, and hospital acquired infections.
Adding to this growing list of effective CME programs, a recent study published in the Journal of Clinical Hypertension concluded that, “an educational program with the support of the medical director of the emergency department (ED) is valuable in the identification of hypertension.”
Background
Hypertension is a major risk factor for coronary events, stroke, congestive heart failure, and peripheral arterial disease. ED physicians have done a poor job in recognizing, treating, and referring patients with hypertension for follow-up care. In addition, many patients being seen for medical care in the ED do not have a primary care physician or access to primary care.
In March 2006, the American College of Emergency Physicians (ACEP) Clinical Policies Subcommittee recommended that patients with hypertension should be referred for follow-up of hypertension and treatment. Previous research by the authors showed that 2.2% of patients seen in the ED did not have their blood pressure (BP) measured. Of the patients who had their BP measured, 38% had hypertension diagnosed, 8% were treated for hypertension in the ED and 53% were referred to a physician or clinic for follow-up of their hypertension.
Methods of Study
Based on these data, an educational program (EP) about the importance of diagnosing hypertension, treating it, and referring patients with hypertension for follow-up care was given to the medical staff of the ED and a grand rounds on this topic given to the medical staff. The medical staff was also taught to obtain follow-up BPs in the ED if the BP was elevated.
After administration of this educational program for 6 months, the researchers audited in a prospective study 602 randomly selected charts of patients seen during a 7-month period (November 2009 through May 2010) in the ED of Westchester Medical Center/New York Medical College for the prevalence of hypertension and how it was managed. Various data were collected about the patients and whether hypertension was treated in the ED and whether the patient was referred to a physician or clinic for follow-up of their hypertension.
This study was approved by the New York Medical College institutional review board and by the institutional review board of Westchester Medical Center.
Results
- Hypertension was treated in the ED in 8% before the educational program and in 10% after the educational program.
- 53% of patients with hypertension before the educational program were referred to a physician or clinic for follow-up of hypertension versus 99.6% after the EP
- A history of hypertension was obtained in 55% with hypertension before the educational program and in 74% with hypertension after the educational program
- A history of treatment for hypertension was obtained in 39% with hypertension before the educational program and in 67% with hypertension after the EP
- BP was not measured in patients seen in the ED in 2.2% of patients before the educational program vs. 0.2% of patients after the educational program
Conclusion
The authors noted hypertension must be treated to decrease cardiovascular events and mortality. To achieve this goal, they recognized that an educational program with the support of the medical director of the ED is valuable in the identification of hypertension with several BP measurements made in the ED, treatment of hypertension in the ED if indicated, and referral of patients to a physician or clinic for follow-up of their hypertension.
This data shows that an educational program administered to the staff of an academic ED significantly increased measurement of blood pressure in the ED, significantly increased obtaining a history of hypertension and of its treatment in ED patients, and significantly increased referral of patients with hypertension to a physician or clinic for follow-up of hypertension.
As more CME programs continue to improve the skills and knowledge of physicians, patient outcomes will continue to improve, saving lives and making our health care system more cost effective and efficient. Future programs should look to this study and research for guidance on how to create effective CME programs that produce positive outcomes for both patients and health care practitioners.