Family physicians' perceptions of academic detailing: a quantitative and qualitative study

<p>Abstract</p> <p>Background</p> <p>The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it.</p> <p>Methods</p> <p>We used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it.</p> <p>Results</p> <p>Overall response rate to the questionnaire was 33% (289/869). Response rate of non-users of academic detailing was 15% (60/393), of users was 48% (229/476). The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists.</p> <p>Conclusion</p> <p>Users of academic detailing highly value its educational value and tend to view information from other sources more critically because of its evidence-based approach. Non-users are unlikely to adopt academic detailing despite its high educational value because they find using office time for CME too much of a barrier. To reach these physicians with academic detailing messages, we will have to find other CME formats.</p

Acute Running and Coronary Heart Disease Risk Markers in Male Cigarette Smokers and Nonsmokers: A Randomized Crossover Trial.

Purpose Cigarette smoking is an independent risk factor for coronary heart disease (CHD) and is associated with impaired postprandial metabolism. Acute exercise reduces postprandial lipemia and improves other CHD risk markers in non-smokers. Less is known about responses in cigarette smokers.Methods Twelve male cigarette smokers (mean(SD) age 23(4) years, BMI 24.9(3.0) kg/m2) and 12 male non-smokers (24(4) years, 24.1(2.0) kg/m2) completed two, 2-day conditions (control, exercise) in a randomised, crossover design. On day 1, participants rested for 9-hours (08:00-17:00) in both conditions except a 60-minute treadmill run (65(7)% peak oxygen uptake, 2.87(0.54) MJ) was completed between 6.5-7.5 h (14:30-15:30) in the exercise condition. On day 2 of both conditions, participants rested and consumed two high-fat meals over 8-hours (09:00-17:00) during which 13 venous blood samples and nine resting arterial blood pressure measurements were taken.Results Smokers exhibited higher postprandial triacylglycerol and C-reactive protein than non-smokers (main effect group effect size (Cohen’s d)≥0.94, P≤0.034). Previous day running reduced postprandial triacylglycerol, insulin and systolic and diastolic blood pressure (main effect condition d≥0.28, P≤0.044), and elevated postprandial non-esterified fatty acid and C-reactive protein (main effect condition d≥0.41, P≤0.044). Group-by-condition interactions were not apparent for any outcome across the total postprandial period (0-8 h; all P≥0.089), but the exercise-induced reduction in postprandial triacylglycerol in the early postprandial period (0-4 h) was greater in non-smokers than smokers (-21% (d=0.43) vs -5% (d=0.16), respectively; group-by-condition interaction P=0.061).Conclusions Acute moderate-intensity running reduced postprandial triacylglycerol, insulin and resting arterial blood pressure the day after exercise in male cigarette smokers and non-smokers. These findings highlight the ability of acute exercise to augment the postprandial metabolic health of cigarette smokers and non-smokers.</div