Using email reminders to engage physicians in an Internet-based CME intervention

BACKGROUND: Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives are to investigate 1) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email announcements, as well as 3) how quickly and when they respond to email announcements. METHODS: Over a 45-week period, 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women's health guideline reinforcing CME activity. Participation was defined as physician log-on at least once to the website. Data were analyzed to determine participation, to compare characteristics of participants with recruited physicians who did not participate, and to determine at what point and when participants logged on. RESULTS: Of 445 recruited physicians with accurate email addresses, 47.2% logged on and completed at least one module. There were no significant differences by age, race, or specialty between participants and non-participants. Female physicians, US medical graduates and MDs had higher participation rates than male physicians, international medical graduates and DOs. Physicians with higher baseline screening rates were significantly more likely to log on to the course. The first 10 emails were the most effective in engaging community-based physicians to complete the intervention. Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday. CONCLUSIONS: Email course reminders may enhance recruitment of physicians to interventions designed to reinforce guideline adoption; physicians' response to email reminders may vary by gender, degree, and country of medical training. Repetition of email communications contributes to physician online participation

Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants

<p>Abstract</p> <p>Background</p> <p>The amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide. However, the process of evaluating these activities is ongoing. This study is a continuation of an earlier report that found online continuing medical education (CME) to be highly effective in making evidence-based decisions.</p> <p>Methods</p> <p>To determine the effectiveness of 114 Internet CME activities, case vignette-based surveys were administered to U.S.-practicing physicians immediately following participation, and to a representative control group of non-participants. Survey responses were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen's <it>d </it>to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions.</p> <p>Results</p> <p>In a sample of 17,142 U.S. physicians, of the more than 350,000 physicians who participated in 114 activities, the average effect size was 0.82. This indicates an increased likelihood of 48% that physicians participating in online activities were making clinical choices based on evidence.</p> <p>Conclusion</p> <p>Physicians who participated in online CME activities continue to be more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes.</p

Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events

<p>Abstract</p> <p>Background</p> <p>Adherence to clinical practice guidelines for management of cardiovascular disease (CVD) is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S. general internists and family physicians in regard to cardiovascular risk management, and examine the association between physician characteristics and cardiovascular risk management.</p> <p>Methods</p> <p>A case vignette survey focused on cardiovascular disease risk management was distributed to a random sample of 12,000 U.S. family physicians and general internists between November and December 2006.</p> <p>Results</p> <p>Responses from a total of 888 practicing primary care physicians who see 60 patients per week were used for analysis. In an asymptomatic patient at low risk for cardiovascular event, 28% of family physicians and 37% of general internists made guideline-based preventive choices for no antiplatelet therapy (p < .01). In a patient at high risk for cardiovascular event, 59% of family physicians and 56% of general internists identified the guideline-based goal for serum fasting LDL level (< 100 mg/dl). Guideline adherence was inversely related to years in practice and volume of patients seen. Cost of medications (87.7%), adherence to medications (74.1%), adequate time for counseling (55.7%), patient education tools (47.1%), knowledge and skills to recommend dietary changes (47.8%) and facilitate patient adherence (52.0%) were cited as significant barriers to CVD risk management.</p> <p>Conclusion</p> <p>Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations. Innovative educational approaches that address barriers may facilitate the implementation of guideline-based recommendations in CVD risk management.</p

A Component-Based Approach for Scientific Services for Education and Research (Scientific SEARCH)

Today’s challenge for retrieving digital information by users such as “students,” educators,” or “researchers” is coping, more than ever before, with the excessive data and information available. The problem is further compounded because of the way scientific knowledge is structured, in terms of expert interviews, articles, conference coverage, journal scans etc. Great progress has been made in digital library research. The NSF/NSDL through their initiatives has assembled a great set of tools and techniques that hold significant potential. Many projects are now underway applying these tools and techniques to meet the information needs of different user communities. The primary focus of Scientific SEARCH project is enhancing access to high quality learning materials and resources, modules, and other digital objects targeted towards scientific consumer and scientific producer. The project will use a multi-phased approach to achieve the objective. The paper describes the first-phase work submitted to NSF 04-542 solicitation

Family physicians' information seeking behaviors: A survey comparison with other specialties

BACKGROUND: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice. METHODS: A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty. RESULTS: Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians. CONCLUSION: Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference

Improving the physician-patient cardiovascular risk dialogue to improve statin adherence

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to evaluate the effectiveness of a patient education program developed to facilitate statin adherence.</p> <p>Methods</p> <p>A controlled trial was designed to test the effectiveness of a multifaceted patient education program to facilitate statin adherence. The program included a brief, in-office physician counseling kit followed by patient mailings. The primary end point was adherence to filling statin prescriptions during a 120-day period. Patients new to statins enrolled and completed a survey. Data from a national pharmacy claims database were used to track adherence.</p> <p>Results</p> <p>Patients new to statin therapy exposed to a patient counseling and education program achieved a 12.4 higher average number of statin prescription fill days and were 10% more likely to fill prescriptions for at least 120 days (<it>p </it>= .01).</p> <p>Conclusion</p> <p>Brief in-office counseling on cardiovascular risk followed by patient education mailings can be effective in increasing adherence. Physicians found a one-minute counseling tool and pocket guidelines useful in counseling patients.</p

Normative Ethics Does Not Need a Foundation: It Needs More Science

The impact of science on ethics forms since long the subject of intense debate. Although there is a growing consensus that science can describe morality and explain its evolutionary origins, there is less consensus about the ability of science to provide input to the normative domain of ethics. Whereas defenders of a scientific normative ethics appeal to naturalism, its critics either see the naturalistic fallacy committed or argue that the relevance of science to normative ethics remains undemonstrated. In this paper, we argue that current scientific normative ethicists commit no fallacy, that criticisms of scientific ethics contradict each other, and that scientific insights are relevant to normative inquiries by informing ethics about the options open to the ethical debate. Moreover, when conceiving normative ethics as being a nonfoundational ethics, science can be used to evaluate every possible norm. This stands in contrast to foundational ethics in which some norms remain beyond scientific inquiry. Finally, we state that a difference in conception of normative ethics underlies the disagreement between proponents and opponents of a scientific ethics. Our argument is based on and preceded by a reconsideration of the notions naturalistic fallacy and foundational ethics. This argument differs from previous work in scientific ethics: whereas before the philosophical project of naturalizing the normative has been stressed, here we focus on concrete consequences of biological findings for normative decisions or on the day-to-day normative relevance of these scientific insights

Designing tailored Web-based instruction to improve practicing physicians\u27 chlamydial screening rates

OBJECTIVE: To design an individualized Web-based continuing medical education (CME) program to improve practicing physicians\u27 chlamydial screening rates. DESCRIPTION: Often unrecognized and untreated, chlamydial infections in young women may cause pelvic inflammatory disease, infertility, and ectopic pregnancy and facilitate the acquisition of HIV. The National Committee for Quality Assurance in 2001 reported chlamydia screening rates to be 23.6% for 16-20-year-olds and 18.3% for 21-26-year-olds. In a collaborative project an academic medical center and a large national managed care organization have developed four tailored Web-based modules for primary care physicians with the goal of improving rates of screening for chlamydia. Each module includes: (1) individual office chlamydial screening rates; (2) interactive cases with real-time comparison of answers with those of peers; (3) a toolbox of office support materials, including patient education materials and guideline summaries; and (4) real-time tailoring of the Web pages based on physicians\u27 interactions with module. Readiness to change and barriers impeding change are assessed during interaction with the module and multiple pathways are created in real time for each physician. Physicians\u27 perceptions of the prevalence of chlamydia in their patient populations and the rate of sexual activity among adolescent girls are also assessed. These variables have been correlated in other studies with low rates of chlamydial screening. Inaccurate perceptions of these variables are considered to constitute a precontemplative stage of change. Specific messages are designed to facilitate increased awareness of chlamydia prevalence, level of sexual activity, and the consequences of failure to screen. For physicians who are aware of the nature and scope of the problems related to chlamydia, messages are tailored to assist them in reducing barriers to screening. A randomized trial of a national sample of primary care physicians is being conducted to determine the effectiveness of this intervention in improving physicians\u27 chlamydial screening rates in sexually active women 16-26 years of age. DISCUSSION: While the Internet offers an educational distribution system accessible to practicing physicians, most CME online programs are text-based and infrequently interactive or guideline-based. It is unlikely that these programs have broad impact on physicians\u27 practice patterns. Neither the broad capacities of Web technologies nor the evidence of effective methods for influencing physicians\u27 practice patterns has influenced the design of most CME programs. The innovative course described above provides individual office feedback on performance, compares physicians\u27 responses with those of their peers, gathers responses to determine physicians\u27 readiness to change practices, and provides branching pathways on-the-fly individualized to these responses. The module format is easily adapted to other diseases, able to be linked in an automated fashion to administrative data files, and relatively low in cost to support