Effect of a Primary Care Continuing Education Program on Clinical Practice of Chronic Obstructive Pulmonary Disease: Translating Theory Into Practice

doi:10.1016/j.mayocp.2012.02.028

Mayo Clinic Proceedings

Volume 87, Issue 9, September 2012, Pages 862-870

https://doi.org/10.1016/j.mayocp.2012.02.028 Get rights and content

Abstract

Objectives

To describe the development and implementation process and assess the effect on self-reported clinical practice changes of a multidisciplinary, collaborative, interactive continuing medical education (CME)/continuing education (CE) program on chronic obstructive pulmonary disease (COPD).

Methods

Multidisciplinary subject matter experts and education specialists used a systematic instructional design approach and collaborated with the American College of Chest Physicians and American Academy of Nurse Practitioners to develop, deliver, and reproduce a 1-day interactive COPD CME/CE program for 351 primary care clinicians in 20 US cities from September 23, 2009, through November 13, 2010.

Results

We recorded responses to demographic, self-confidence, and knowledge/comprehension questions by using an audience response system. Before the program, 173 of 320 participants (54.1%) had never used the Global Initiative for Chronic Obstructive Lung Disease recommendations for COPD. After the program, clinician self-confidence improved in all areas measured. In addition, participant knowledge and comprehension significantly improved (mean score, 77.1%-94.7%; P<.001). We implemented the commitment-to-change strategy in courses 6 through 20. A total of 271 of 313 participants (86.6%) completed 971 commitment-to-change statements, and 132 of 271 (48.7%) completed the follow-up survey. Of the follow-up survey respondents, 92 of 132 (69.7%) reported completely implementing at least one clinical practice change, and only 8 of 132 (6.1%) reported inability to make any clinical practice change after the program.

Conclusion

A carefully designed, interactive, flexible, dynamic, and reproducible COPD CME/CE program tailored to clinicians' needs that involves diverse instructional strategies and media can have short-term and long-term improvements in clinician self-confidence, knowledge/comprehension, and clinical practice.

Section snippets

Analysis, Design, Development, Implementation, and Evaluation: Analysis Phase and Study Population

We used Analysis, Design, Development, Implementation, and Evaluation (ADDIE), a systematic approach to instructional development, to design the program. Step 1 (analysis phase) was to perform a needs assessment and identify clinical and educational practice gaps. Because physician self-assessment is unreliable,2, 5 we used literature reviews, interviews, survey data, and expert opinion to assess COPD care gaps.⁶ The needs assessment highlighted practice gaps of what currently is happening in

Results

Three hundred fifty-one participants attended one of the interactive CME/CE programs. We recorded responses to demographic, self-confidence, and knowledge/comprehension questions by using an audience response system. Of the respondents to the audience response system, 237 of 322 (73.6%) were women and 180 of 351 (51.3%) were APNs (Table 2). Before attending the program, 173 of 320 participants (54.1%) had never used the GOLD recommendations. Clinician self-confidence improved after the course

Discussion

We describe our experience designing and implementing a successful interactive, multimedia, multidisciplinary, collaborative CME/CE COPD program for primary care clinicians in 20 cities across the United States. We based the foundation of this unique program on adult learning and instructional design principles and the ACCP 6 learning categories. Our data suggest that this program is associated with clinical practice changes and significant improvements in clinician self-confidence and

Conclusions

Using diverse instructional models, teaching techniques, and media, we created an interactive, dynamic, collaborative, multidisciplinary, and reproducible CME/CE program for primary care clinicians throughout the United States. This program addresses practice gaps in COPD recognition and management and is associated with substantial self-reported changes in clinical practice. We developed this unique educational program by (1) linking instructional methods to outcome strategy, (2) creating

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: Potential Competing Interests: Dr Adams discloses the following: investigator/grant research: National Institute of Health, Veterans Affairs Cooperative Studies Program, Bayer Pharmaceuticals Corp, Boehringer Ingelheim Pharmaceuticals Inc, Centocor Inc, GlaxoSmithKline, Novartis Pharmaceuticals AG, Pfizer Inc, and Schering-Plough Corp; honoraria for speaking at CE programs (unrestricted grants for CE): AstraZeneca Pharmaceuticals LP, Bayer Pharmaceuticals Corp, Boehringer Ingelheim Pharmaceuticals Inc, GlaxoSmithKline, Novartis Pharmaceuticals AG, Pfizer Inc, and Schering-Plough Corp. Ms Pitts and Mr Dellert are both employees of the ACCP. Ms Wynn is employed by the AANP. Dr Yawn discloses the following: research support from Aerocrine, Boehringer Ingelheim, Forrest, GlaxoSmithKline, and Novartis. Dr Hanania discloses the following: investigator/research support from Astra Zeneca, Boehringer Ingelheim, GlaxoSmithKline, MedImmune, Novartis, Pfizer, and Sunovion; speaker bureau of Boehringer Ingelheim, GlaxoSmithKline, and Pfizer; advisory board/consultancy for Dey Inc, GlaxoSmithKline, Novartis, Pearl, and Pfizer. The programs described were conducted and sponsored by the ACCP and the AANP, which received unrestricted grants from AstraZeneca Pharmaceuticals LP, Wilmington, DE, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, and GlaxoSmithKline Pharmaceuticals Ltd, Philadelphia, PA. The funders of the unrestricted grants were not involved in the development or implementation of these programs, in the interpretation of the data, or in the preparation, review, or any part of the manuscript.

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Original articleEffect of a Primary Care Continuing Education Program on Clinical Practice of Chronic Obstructive Pulmonary Disease: Translating Theory Into Practice

Abstract

Objectives

Methods

Results

Conclusion

Section snippets

Analysis, Design, Development, Implementation, and Evaluation: Analysis Phase and Study Population

Results

Discussion

Conclusions

Chest

Chest

Chest

Chest

Am J Pharm Educ

Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities

J Contin Educ Health Prof

Redesigning Continuing Education in the Health Professions: Summary

Accuracy of physician self-assessment compared with observed measures of competence: a systematic review

JAMA

Learning needs assessment: assessing the need

BMJ

Global strategy for diagnosis, management, and prevention of COPD

Enhancing COPD management in primary care settings

MedGenMed

Confronting COPD in America: executive summary

Detection of asthma and chronic obstructive pulmonary disease in primary care

Eur Respir J Suppl

Original article
Effect of a Primary Care Continuing Education Program on Clinical Practice of Chronic Obstructive Pulmonary Disease: Translating Theory Into Practice