Time course of change in prescription behaviour after targeted continuing medical education in a closed loop system of repeated standardised documentation and feedback

Abstract

Objective. This study investigates whether introducing targeted CME into a regular feedback system being part of a disease management programme (DMP) will improve prescription behaviour, and if yes, how long it will take to demonstrate this effect and what could be the magnitude of such an effect. Methods. From the database of the DMP coronary artery disease (CAD) in the two German regions of North Rhine (NR) and Westphalia Lippe (WL), respectively, all patients with heart failure in New York Heart Association (NYHA) class II and III were extracted. Prescription of combination therapy (ACE inhibitor, ACE-I, and beta blocker, BB), as recommended by the guidelines, was prospectively monitored for 6 years after this topic was addressed in a series of accredited CME modules. These modules were part of extended feedback reports for NR physicians, while physicians in WL received basic feedback reports only. Data were analysed according to participants vs. non-participants in CME vs. control group (WL). Results. The largest increase was observed with regard to the additional prescription of an ACE-I in patients who only received a BB at baseline. BB prescription rates increased to a lesser extent. But for both drugs, prescription rates did not reach their maximum even at the end of the 6 years' observation period. Significant differences in prescription rates in favour of patients of CME participants could only be demonstrated after 3 years from the first CME article. Conclusions. The DMP CAD has to be considered as a multifaceted intervention which significantly changes prescription behaviour. Combination of the DMP with a further multifaceted intervention (print CME) added only little to this effect. The time course of change makes it difficult exclusively to relate the observed changes in prescription rates to the CME intervention.

Database Supported Long-term Management of Chronic Diseases – Data from the German Disease Management Programmes as a Source for Continuing Medical Education

“…Furthermore, DMP data have also yielded insights relevant to methodology used for needs assessment in CME [ 15 , 17 ].…”

“… - The data presented here relate to only one federal state in Germany and may thus not be representative for Germany as a whole. - Although the DMPs themselves may be considered as an intervention [ 15 ] DMP data should be considered as essentially observational. …”

Cologne Consensus Conference 2016: assessment in accredited CME/CPD, 16 and 17 September 2016, Cologne, Germany

“…The prescribing behaviour of those receiving the CME articles was compared with another cohort who did not receive the CME articles. The details of the study have previously been published in the Journal of European CME [2] and pointed to a long-term improvement of approximately 5% in adherence to guidelines by the participants receiving CME articles as part of their feedback. However, as pointed out by Dr Hagen and other conference participants during discussion, the effect of such interventions is small, and multiple CME interventions plus feedback may be needed to translate into significant improvements in patient care.…”

Proposal for a graded approach to disclosure of interests in accredited CME/CPD

“…Our approach to disclosure of COI may be associated with adverse effects including "strategic exaggeration" and "moral licensing," 45 which in the end may lead to a reduction of trust and (potentially) unwarranted skepticism 38 and may reduce the application of evidence-based medicine. 46 Thus, disclosure of COI should always be considered only as part of a more comprehensive strategy for mitigation of COI.…”