Advertisement
ADVANCED SEARCH

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Borgiel, A. E.M. Articles by Bass, M. J. Search for Related Content PubMed PubMed Citation Articles by Borgiel, A. E.M. Articles by Bass, M. J. Related Collections Quality improvement Postgraduate: CME, CPD Other family medicine

Evaluating the effectiveness of 2 educational interventions in family practice

Alexander E.M. Borgiel, MD, J. Ivan Williams, PhD^*, David A. Davis, MD^¶**, Earl V. Dunn, MD, Neil Hobbs, MB BCh^***, Brian Hutchison, MD, C. Ruth Wilson, MD^***, Jamie Jensen, Jennifer J.S. O'Neil, BSc and Martin J. Bass, MD, MSc

From *the Institute for Clinical Evaluative Sciences, Toronto, Ont.; the Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.; the Departments of Family and Community Medicine, Public Health Sciences and ¶Health Administration and **Continuing Education, Faculty of Medicine, University of Toronto, Toronto, Ont.; the Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab Emirates; the Departments of Family Medicine and Clinical Epidemiology and Biostatistics and ¶¶the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ont.; ***the Department of Family Medicine, Queen's University, Kingston, Ont.; and the College of Family Physicians of Canada, Mississauga, Ont. Professor (deceased), Department of Family Medicine, University of Western Ontario, London, Ont.

Abstract

Background: Structured feedback of information can produce change in physician behaviour. The objective of this study was to assess the effectiveness of 2 educational interventions for improving the quality of care provided by family physicians in Ontario: the Practice Assessment Report (PAR) and the Continuing Medical Education Plan (CMEP) with a follow-up visit by a mentor.

Methods: The study was a randomized controlled trial. Physicians in the control group received only the PAR, whereas those in the experimental group received the PAR, CMEP and mentor interventions. The participants were 56 family physicians and general practitioners (27 in the PAR group and 29 in the CMEP group) in southern Ontario who agreed to participate in the interventions and provide data. A total of 2395 patients randomly sampled from the practices returned questionnaires and consented to have their medical records abstracted. The outcome measures were global scores in 4 areas - quality of care, charting, prevention and overall use of medications - and patient ratings of satisfaction with care and preventive practices. The measures were applied at the beginning (phase 1) and end (phase 2) of the study.

Results: The mean global scores at the end of the study for the PAR group were 70.1% for quality of care, 84.7% for prevention, 77.7% for charting and 82.2% for overall use of medications. The corresponding scores for the CMEP group were 68.3%, 82.1%, 76.4% and 83.2%. In the patient satisfaction component, the personal care scores at phase 2 were 93.6% for the PAR group and 94.6% for the CMEP group. Examples of the scores for prevention for the PAR group were 98.3% for children's current immunization, 96.6% for blood pressure measured within the previous 5 years, 79.4% for referral of women of the appropriate age for mammography within the previous 2 years, and 58.4% for discussion about alcohol use. The corresponding scores for the CMEP group were 95.8%, 97.6%, 77.6% and 64.6%. The changes in mean scores between phase 1 and phase 2 ranged from -1.9 to 2.3 points. There were no significant differences between the 2 groups in phase 1 or phase 2 scores or in change in scores. A total of 64.3% of the physicians rated the PAR as useful, 26.5% found the CMEP to be useful, and 41.0% considered the mentor strategy to be a useful form of continuing medical education. Although changes in practice related to the PAR, CMEP or mentor were reported by some physicians, they were not related to chart audit or patient scores.

Interpretation: Educational interventions based on quality-of-care assessments and directed to global improvements in quality of care did not result in improvements in the outcome measures. Educational interventions may have to be targeted to specific areas of the practice, with physicians being monitored and receiving ongoing feedback on their performance.

This article has been cited by other articles:

				N. M. Salbach, P. Veinot, S. Rappolt, M. Bayley, D. Burnett, M. Judd, and S. B. Jaglal Physical Therapists' Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study Physical Therapy, June 1, 2009; 89(6): 556 - 568. [Abstract] [Full Text] [PDF]

				M. Stewart, J. B. Brown, J. Hammerton, A. Donner, A. Gavin, R. L. Holliday, T. Whelan, K. Leslie, I. Cohen, W. Weston, et al. Improving Communication Between Doctors and Breast Cancer Patients Ann. Fam. Med, September 1, 2007; 5(5): 387 - 394. [Abstract] [Full Text] [PDF]

				P. Midlov, A. Bondesson, T. Eriksson, C. Nerbrand, and P. Hoglund Effects of educational outreach visits on prescribing of benzodiazepines and antipsychotic drugs to elderly patients in primary health care in southern Sweden Fam. Pract., February 1, 2006; 23(1): 60 - 64. [Abstract] [Full Text] [PDF]

				B. Hutchison, T. Ostbye, J. Barnsley, M. Stewart, M. Mathews, M. K. Campbell, E. Vayda, S. B. Harris, V. Torrance-Rynard, and C. Tyrrell Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study Can. Med. Assoc. J., April 15, 2003; 168(8): 977 - 983. [Abstract] [Full Text] [PDF]

				S. de Lusignan, P. N Stephens, N. Adal, and A. Majeed Does Feedback Improve the Quality of Computerized Medical Records in Primary Care? JAMIA, July 1, 2002; 9(4): 395 - 401. [Abstract] [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-1999, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.