Effect of a primary care continuing education program on clinical practice of chronic obstructive pulmonary disease: translating theory into practice

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.

FIGURE 1

Percentage of participants feeling not comfortable, somewhat comfortable, comfortable, or confident with managing chronic obstructive pulmonary disease (COPD), interpreting spirometry, and managing acute exacerbations of COPD before and after the program.

FIGURE 2

Percentage of commitments addressing a variety of topics grouped in categories that were not implemented vs those that were at least partially implemented by study participants. Topics included the following: spirometry—increase spirometry use, personally interpret more spirometry tests, or acquire a spirometer for the office; case finding—implement a chronic obstructive pulmonary disease (COPD) screener questionnaire and ask more questions about subtle respiratory symptoms in smokers older than 40 years; guidelines—implement the Global Initiative for Chronic Obstructive Lung Disease recommendations in daily practice, use long-acting bronchodilators as first-line therapy in COPD, send patients with COPD to pulmonary rehabilitation, reduce risk factors, and improve management of acute exacerbations; smoking—ask every patient about smoking status, advise every smoker to quit, and increase smoking cessation counseling; inhalers—instruct patients in proper inhaler use and ask patients to perform return demonstration to ensure proper technique; billing—start coding and billing for spirometry; comorbidities—search for and address comorbidities, such as depression, anxiety, osteoporosis, and cardiovascular disease, in patients with COPD; α₁-antitrypsin—start testing patients with COPD for α₁-antitrypsin deficiency; and other (not shown in figure).