A Multifaceted Continuing Medical Education Intervention to Improve Primary Care Physicians Performa

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A Multifaceted Continuing Medical Education
Intervention to Improve Primary Care Physicians
Performance In Mexico Hortensia Reyes, Ricardo
Perez-Cuevas, Sergio Flores, Patricia Tome, Juan
A Trejo, Onofre MuñozMexican Institute of
Social Security
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Background

• Inappropriate case management for common diseases
  in primary care level is a relevant problem in
  many countries.
• Most of continuing medical education activities
  for primary care physicians in Mexico have not
  impact in improving the quality of care they
  provide.
• Physicians practices are not always in
  accordance with updated clinical evidence.

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Objective

• To evaluate the impact of a multi-faceted
  educational intervention on primary care
  physicians, to improve case-management of acute
  respiratory infections, hypertension and type 2
  diabetes

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Methods

• Design Non-randomised prospective
  controlled Trial
• Setting Eight primary care facilities
  belonging to Mexican Institute of Social
  Security, in four different regions of Mexico
• Study
• population Family physicians

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Methods

• Components
• Formulation of evidence-based clinical guidelines
• Training of selected clinical tutors from
  referral hospital
• Educational intervention

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Educational intervention activities

• The multifaceted strategy comprises three stages
  to be completed in a seven-month period
• Interactive workshops
• In-service training through individual tutorial
• Round-table Peer review sessions

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Outcome measures

• Appropriateness of physicians case-management
  according to the clinical guideline
• ARI - Prescription of antibiotics
• - Patients education, including mothers
• education whether the patient was a
  child, regarding the alarm signs
• HT - Prescription of antihypertensive drugs
• DM - Prescription of hypoglycemic drugs or
  insulin
• In both chronic illnesses dietary and
• exercise recommendations

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Evaluation

• Acute respiratory infections
• baseline evaluation
• follow-up evaluations after every intervention
  stage
• Hypertension and Type 2 diabetes
• baseline evaluation
• Follow-up at six and twelve
• months
• Evaluations consisted of
• Interviewing patients
• Reviewing clinical records
• Reviewing prescriptions

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Results Impact of the intervention on the three
causes of visit
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Impact of the intervention on the treatment of
Acute Respiratory Infections
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Impact of the intervention on the treatment of
Type 2 Diabetes
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Impact of the intervention on the treatment of
Hypertension
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Methodological aspectsStrengths

• Design of the intervention
• Multifaceted intervention workshop and
  peer-review activities, reinforced by
• Clinical guidelines developed with the
  consensus and participation of the physicians
  and adapted to the local conditions
• Individual tutorial activity. Clinical analytical
  skills can be learned at the moment of medical
  practice

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Methodological aspectsStrengths

• Ascertainment of the impact of the intervention
• Baseline and at least two follow-up evaluations
  in experimental and control groups
• Observation of actual physicians practices

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Methodological aspectsWeaknesses

• Non-randomised, Open-labeled study
• Follow-up evaluations were made immediately
  after each stage
• Lack of information regarding concurrent CME
  activities in which control group physicians
  participated during the study

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QUESTIONS FOR THE FUTURE RESEARCH AGENDA

• Analysis of organizational implications
• Economic evaluation
• Evaluation of sustainability of the
  intervention CME Program
• Impact on health outcomes