The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

Abstract

Study Objective: To evaluate the effect of continuing medical education (CME) activities on patient reported outcomes with regard to (1) screening for excessive sleepiness (ES) and obstructive sleep apnea (OSA) and (2) appropriate referral and treatment. Methods: A total of 725 patients were recruited from 75 providers who either participated or did not participate in Transtheoretical Model (TTM)-based OSA CME activities. Patient reported outcomes from participating (n = 36) and non-participating providers (n = 39) were compared using generalized estimating equations examining random effects of provider as unit of assignment. Results: Patients' reports demonstrate that participating physicians were 1.7 times more likely to initiate discussion of sleep problems than non-participating physicians (t 1,411 = 3.71, p = 0.05) and 2.25-2.86 times more likely to administer validated measures for OSA (Epworth Sleepiness Scale and STOP-BANG). Patient reports also indicated that participating clinicians (79.9%) were signifi cantly more likely to recommend seeing a sleep specialist compared to non-participating clinicians (60.7%; t 1,348 = 9.1, p < 0.01, OR = 2.6). Furthermore, while 89.4% of participating clinicians recommended a sleep study, only 73.2% of the non-participating physicians recommended one (t 1,363 = 11.46, p < 0.001, OR = 3.1). Conclusions: Participation in TTM-based OSA CME activities was associated with improved patient reported outcomes compared to the non-participating clinicians. Keywords: obstructive sleep apnea, patient-reported outcomes, continuing medical education, behavior change, stages of change, Transtheoretical Model Citation: Johnson SS, Castle PH, Van Marter D, Roc A, Neubauer D, Auerbach S, DeAguiar E. The effect of physician continuing medical education on patient-reported outcomes for identifying and optimally managing obstructive sleep apnea.

Costs and Cost-Effectiveness of mCME Version 2.0: An SMS-Based Continuing Medical Education Program for HIV Clinicians in Vietnam

“…47 We also note that although it was not possible to link definitively the changes in behavior we observed in the trial to specific practical behaviors in clinical practice, such changes are likely given the link between CME and clinical care in a variety of settings. [23][24][25][26][27][28][29][30][31][32][33][34] Similarly, there would be clear benefit in showing that CME leads to improved patient outcomes, but this would require 2 things that are challenging to obtain. First is the time needed to measure the cumulative impact of education on medical skills, which one can predict would take years to manifest (not a realistic goal for a 6-month intervention).…”

“…However, there is every reason to feel confident that clinical skills improved, given studies showing that HIV patients who are managed by clinicians with greater knowledge and expertise receive more appropriate care. [23][24][25][26][27][28][29][30][31][32][33][34] Decisions on expansion and scale-up of novel interventions must be guided not just on benefit but also on cost. Yet, the published literature on economic evaluations of mHealth interventions generally is sparse.…”

Patients’ symptoms as a reason for consulting a doctor and obtaining a diagnosis of obstructive sleep apnea

“…The majority of papers like this one stress the need for more education of general and clinical physicians. In this way they will recognize the disease early enough to diagnose OSA and to provide proper treatment to OSA patients [20].…”

Continuing Medical Education in the Post COVID-19 Pandemic Era

“…CME is most effective when it is interactive, involves multiple exposures, and focuses on topics that clinicians view as important and timely [4]. When properly delivered, CME offers numerous benefits, including enhancing clinician knowledge, skills, and attitudes, improving patient outcomes, and lowering health care costs [5][6][7][8][9][10].…”