Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model--a randomized controlled study

Shirazi, Mandana; Zeinaloo, Ali Akbar; Parikh, Sagar V.; Sadeghi, M R; Taghva, Arsia; Arbabi, Mohammad; Kashani, Ahmad Sabouri; Alaeddini, Farshid; Lonka, Kirsti; Wahlström, Rolf

doi:10.1093/fampra/cmn008

Cited by 19 publications

(21 citation statements)

References 20 publications

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“…26 These results add to the growing evidence to support clinician education based on readiness to change. [22][23][24] The findings are similar to those of Shirazi and colleagues, 24 who reported that education tailored to different stages of readiness to address depression in primary care enabled clinicians to move to more advanced stages of readiness, and the findings of Johnson et al 26 who reported that TTM-based CME for specialists increased readiness to employ best practices in individualizing early and aggressive treatment of rheumatoid arthritis. The appeal of this type of approach to improve clinical practice is enhanced when one considers how cost-effectively online CME can be provided and the convenience if offers clinicians.…”

Section: Discussionsupporting

confidence: 74%

“…20,21 Tailoring educational content to readiness to adopt a performance change is also likely to play a key role. [22][23][24][25] The Transtheoretical Model (TTM) is an integrative model that describes behavior change as a progression through a series of five stages of readiness: (1) Precontemplation: not intending to adopt the best practices, (2) Contemplation: intending to adopt the best practices in the next six months, (3) Preparation: intending to adopt the best practices in the next 30 days, (4) Action: adopted the best practices less than six months ago, and (5) Maintenance: adopted the best practices more than six months ago. The TTM could provide a useful framework for tailoring CME content in that leveraging the principles of the TTM permits the inclusion of behavior change statements to ensure activities meet the needs of all physicians, even those who are not prepared to adopt the desired performance.…”

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

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The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

Johnson

Castle

Marter

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objective: To evaluate the effect of continuing medical education (CME) activities on patient reported outcomes with regard to (1) screening for excessive sleepiness (ES) and obstructive sleep apnea (OSA) and (2) appropriate referral and treatment. Methods: A total of 725 patients were recruited from 75 providers who either participated or did not participate in Transtheoretical Model (TTM)-based OSA CME activities. Patient reported outcomes from participating (n = 36) and non-participating providers (n = 39) were compared using generalized estimating equations examining random effects of provider as unit of assignment. Results: Patients' reports demonstrate that participating physicians were 1.7 times more likely to initiate discussion of sleep problems than non-participating physicians (t 1,411 = 3.71, p = 0.05) and 2.25-2.86 times more likely to administer validated measures for OSA (Epworth Sleepiness Scale and STOP-BANG). Patient reports also indicated that participating clinicians (79.9%) were signifi cantly more likely to recommend seeing a sleep specialist compared to non-participating clinicians (60.7%; t 1,348 = 9.1, p < 0.01, OR = 2.6). Furthermore, while 89.4% of participating clinicians recommended a sleep study, only 73.2% of the non-participating physicians recommended one (t 1,363 = 11.46, p < 0.001, OR = 3.1). Conclusions: Participation in TTM-based OSA CME activities was associated with improved patient reported outcomes compared to the non-participating clinicians. Keywords: obstructive sleep apnea, patient-reported outcomes, continuing medical education, behavior change, stages of change, Transtheoretical Model Citation: Johnson SS, Castle PH, Van Marter D, Roc A, Neubauer D, Auerbach S, DeAguiar E. The effect of physician continuing medical education on patient-reported outcomes for identifying and optimally managing obstructive sleep apnea.

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Section: Discussionsupporting

confidence: 74%

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

Johnson

Castle

Marter

et al. 2015

Journal of Clinical Sleep Medicine

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“…The 192 GPs were first grouped according to their expressed stages of readiness to change and stratified based on gender, age, and length of work experience (three levels) [20]. Thereafter, they were randomly allocated within each subgroup to the intervention ( n = 96) or the control arm ( n = 96).…”

Section: Methodsmentioning

confidence: 99%

“…The content stressed recognition and diagnosis rather than treatment. The trans ‐theoretical model postulates that physicians who already are in the intention stage of change should be given material and specific educational formats that emphasize practical treatment strategies and clarification of differential diagnoses, because they are ready to accept this [20]. Therefore, as GPs in the small intervention group were all in the intention stage, they participated in a workshop setting, mainly using case illustrations presented through SPs, role playing, cooperative learning techniques (e.g.…”

Section: Methodsmentioning

confidence: 99%

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial

Shirazi

Lonka

Parikh

et al. 2011

Evaluation Clinical Practice

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“…Two important personal attributes - self-efficacy and readiness to change - have been associated with health behavior change in patients and to a lesser extent to use of guidelines by clinicians 17–20 . Self-efficacy, (the degree of confidence in one’s capacity for success in implementing a goal-directed behavior 21 ), is a personal attribute that is central to social learning theory (SLT) 22 .…”

Section: Introductionmentioning

confidence: 99%

Improving Clinician Self-Efficacy Does Not Increase Asthma Guideline Use by Primary Care Clinicians

Cloutier

Tennen

Wakefield

et al. 2012

Academic Pediatrics

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Objectives The association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing©) was examined. Methods A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy. Results At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (Relative Rate (RR) 1.34 (95% Confidence Interval 1.04, 1.72), p=0.04) but not treatment plan development (RR 0.63 (0.29, 1.35), p=.23) or anti-inflammatory use (RR 1.76 (0.92, 3.35), p=.09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (p=0.01) and more clinicians were in an action stage of change (p=0.001) but these changes were not associated with changes in primary or secondary outcomes. Conclusions Self-efficacy scores correlated with program use at baseline and increased in the intervention arm but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.

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Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model--a randomized controlled study

Cited by 19 publications

References 20 publications

The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial

Improving Clinician Self-Efficacy Does Not Increase Asthma Guideline Use by Primary Care Clinicians

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