Complex cases in primary care: report of a CME-certified series addressing patients with multiple comorbidities

Abstract

Aim: To assess whether participation in a series of continuing medical educationcertified activities presenting complicated case scenarios resulted in evidence-based decision making for patients with chronic comorbid conditions. Methods: A series of interactive live workshops and online case studies presented evidence-based, practical information addressing the care of patients with multiple chronic diseases to primary care physicians. Clinical case vignettes were used to assess workshop participant knowledge and competence. Results were compared with those of matched non-participant controls. Online participants were surveyed to evaluate immediate knowledge gains from the activity. Results: Overall, physician workshop participants were 27% more knowledgeable of evidence-based treatment decisions. Participants were more likely to refer a patient with rheumatoid arthritis to a rheumatologist (57% vs. 36%; p = 0.035) and showed better recognition of medications that can contribute to overactive bladder symptoms (36% vs. 18%; p = 0.043) compared with non-participant controls. Non-significant differences in favour of participants included evidence-based decisions regarding the management of osteoporosis, attention deficit hyperactivity disorder in adults and type 2 diabetes mellitus in adolescents. Online participants demonstrated significant knowledge gains (p < 0.001) on 17 of 18 assessment questions across all therapeutic areas. Discussion: Chronic comorbid conditions afflict a sizable minority of patients. However, specific recommendations and education surrounding patient management are often overlooked because of the inherent difficulty of treating this group. Highly interactive educational activities can improve participant knowledge and competency in treating these patients by providing an opportunity to interact with faculty experts, receive immediate feedback and practice new skills. Conclusion: Interactive educational activities that discuss complicated case scenarios can improve participant application of evidence-based medicine for patients with multiple chronic comorbidities. What's knownMultiple chronic conditions affect a large number of patients, yet education on how to treat these difficult cases is lacking. What's newEducational activities directed towards evidencebased care of patients with multiple chronic conditions and that use an interactive format can promote knowledge and competency among physician participants.

Training Doctors to Manage Patients with Multimorbidity: A Systematic Review

“…Both studies had non-randomized controlled trial designs with one (Andolsek et al . [ 30 ]) being a non-randomized controlled study and the other (Maguire et al . [ 31 ]) being an uncontrolled before and after study, described as a pilot study.…”

“…As summarized in Table 2 , Andolsek et al . reported on a half-day workshop for family physicians and internal medicine physicians, physician assistants, and nurse practitioners, which addressed complex clinical scenarios [ 30 ]. While multimorbidity is not defined in this paper, the cases described had multiple, co-existing chronic conditions.…”

“…Andolsek et al ’s workshops comprised two parts: a large group presentation during which guidelines, algorithms, and clinical evidence were summarized by primary care faculty; followed by small group discussions about developing plans for the diagnosis and management of a number of complex case scenarios [ 30 ]. Their intervention group of 487 practitioners contained 307 doctors, while their control group comprised 992 participants, 605 of whom were doctors.…”

“…The control group in this study did not attend the live workshop, but completed a complex cases module online which incorporated the content of the workshop and evidence-based strategies for management of patients with multimorbidity. The effectiveness of the online module was measured using the same questionnaire that evaluated the workshop, administered both before and immediately after each online case study [ 30 ].…”

“…The clinical topics included in the intervention developed by Andolsek et al . were based on an ‘independent educational needs assessment conducted by DukeCME and the accredited continuing medical education (CME) provider’ [ 30 ]. Andolsek et al suggest that realistic, occupationally appropriate settings, with an opportunity to discuss the cases with colleagues, should be used to deliver novel clinical information, referencing a paper by Moore et al .…”