Evaluating the Impact of an Educational Program on Practice Patterns of Canadian Family Physicians Interested in Depression Treatment

Abstract

BACKGROUND: Depression is frequently unrecognized and undertreated. Therefore, there is a need to increase the knowledge and skills of primary care physicians regarding the diagnosis and treatment of depression. The aim of this study was to provide, and evaluate the impact of, a brief educational program with a number of practice tools and resources in order to improve family physicians' knowledge, diagnosis, and treatment of depression. METHODS: Two educational programs (general and enhanced) were delivered to family physicians interested in depression treatment. The enhanced program focused on more practical clinical issues such as use of diagnostic and symptom assessment tools, recommended dosing of citalopram, how to initiate and discontinue treatment, and relapse prevention. Physicians' knowledge of depression was assessed pretraining and posttraining. Chart audits were conducted for 6 months. Primary endpoints were recognition of depression and pharmacologic management (initial dose, maximum dose, length of treatment, adverse events, and concomitant psychotropic drugs). Secondary endpoints were patient satisfaction with treatment, compliance, withdrawal from the study, treatment outcome, use of adjunctive psychotherapy, and number of office visits. RESULTS: There was a global increase in physicians' knowledge of depression in the short term. Physicians in the enhanced group were more likely to use a symptom-based diagnostic checklist, record the diagnosis of depression, and prescribe the recommended initial dose of citalopram, and they referred less frequently for adjunctive psychotherapy. No difference between educational intervention groups was found in patient satisfaction, compliance, and treatment outcome. CONCLUSIONS: A well-designed brief, simple, and low-cost educational program can increase family physicians' knowledge of depression, improve their diagnostic skills, and optimize their treatment of depression.

A tool for evaluating the potential for cost-effective outcomes measurement

“…Patient level outcomes (changes in patient health status) require access to physicians’ actual patient data and may be limited by Health Insurance Portability and Accountability Act regulations. There are a number of studies showing that all formats of CME are effective in changing physicians’ behavior to some extent 4–20. However, in our experience, these changes are small and sometimes difficult to measure even using chart reviews.…”

The Future of Continuing Medical Education

“…Of these, just under half (18 studies) 4,5,9,21,23,[25][26][27]38,39,41,43,45,46,51,100,101,108 demonstrated a positive effect. In contrast, 8 studies 27,52,61,62,64,69 -71 did not meet their objectives, 5 85,86,88,90,91 lacked a control group, and 6 75,76,78 -81 showed mixed results. Therefore, a single CME exposure may have a positive short-and long-term effect on practice behavior objectives.…”

“…Nine studies 96,100 -107 met objectives using multiple media but did not specify the timing of evaluation. In contrast, 4 studies 59,76 -78 showed mixed results over the long term, 14 7,18,33,34,53,54,56,57,59,61,64,65,67,69 did not achieve their objectives, and 3 83,88,92 did not include a control group. Overall, most studies suggested that CME activities that use multiple media have both a short-and a long-term effect on practice behavior objectives.…”

“…Nine studies 58,59,[75][76][77][78][79][80][81] showed mixed results, whereas one 18 was unclear about whether it met objectives. Fourteen studies [82][83][84][85][86][87][88][89][90][91][92][93][94][95] lacked a control group; thus, no reliable measurement of effect could be made.…”

The Development and First Use of the QUEST Measures to Evaluate School Nurses' Knowledge and Skills for Depression Recognition and Management

“…Educational initiatives have been devised to improve depression knowledge and recognition among professionals, carers, and service users, and a number of instruments have been developed to evaluate outcomes 16–19 . However, in general there has not been adequate examination of the characteristics of these instruments.…”