Long-term effects of asthma education for physicians on patient satisfaction and use of health services

Abstract

This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance.Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1±12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines.Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine.It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care. Annual expenditure by individuals, professional societies, and corporations on professional education are considerable as this form of learning is thought to be a major way in which physicians keep abreast of changes in clinical practice. Nonetheless, little information evaluated by randomized controlled study designs exists in the literature about the impact of education for practicing physicians on the health status of their patients. While studies of continuing medical education are rare [1±3], fewer still are available to assess the persistence or decline of effects over the longer term. Developing potent interventions for clinicians, that change their practices and result in desirable patient outcomes, is important for ultimately improving healthcare and reducing costs.There are at least three reasons for why providing effective continuing education is salient in asthma control. Firstly, a chronic disease like asthma requires an ongoing partnership between clinician and patient and the nature of that relationship has only recently received attention in research [4]. Not all physicians are aware of the elements of partnership (for exam...

Continuing medical education for asthma in primary care settings: a review of randomised controlled trials

“…When patients were followed up two years later, most of these benefits were no longer found. 15 The finding that there are only limited and short-term benefits for patients following provider education are similar to those reported previously from larger reviews of studies conducted in other health care settings and of patients with other medical conditions. [6][7][8][9] There are a number of reasons that can potentially explain the lack of any strong effect.…”

“…The intervention group had fewer hospital admissions, Emergency Department visits, scheduled visits for asthma, and number of days with symptoms in spring and summer, but only for patients who began using inhaled corticosteroids during the trial. When patients were followed up two years later 15 patients treated by physicians in the intervention group only differed from patients in the control group by number of admissions to hospital. Participants who had more than three ED visits at baseline and whose GP received the intervention had a reduced number of ED visits at follow up.…”

“…The four studies [14][15][16][17] included analyses of health benefits to patients with asthma following CME delivered to GPs in the United States, 14,15 Netherlands, 16 and England. 17 They reported varying levels of success in terms of benefits to patients.…”

“…If the data is to be analysed at a GP or patient level, then adjustments for clustering need to be made. While Smeele et al 16 and Clarke et al 14,15 made adjustments for clustering effects, White et al 17 did not include this in their analyses. Adjustment for the effects of clustering should be made in the analysis of results however this can be compensated for in the design of a trial when sample size is calculated, such that sample size is increased and issues like variability in size of practice and patient population are factored into the sample size calculations.…”

“…Both Clarke et al 14,15 and White et al 17 only recruited a single physician from each clinic, and then randomisation was performed at the clinic level. Selecting only one GP in each clinic leads to the problem of ensuring continuity of care during the time frame of the study.…”