Use of CME to impact self-reported changes in the evaluation and management of anaemia in geriatric patients

Abstract

Objective. The Third US National Health and Nutrition Examination Survey (NHANES III) prompted the recognition of geriatric anaemia as a public health concern since ~10% of people aged 65 years or older were anaemic. The objective of this study was to design and implement a continuing medical education (CME) event that motivates and guides Primary Care Health Practitioners (PCHPs) to adopt medical practices that improve outcomes among geriatric patients with anaemia by employing effective diagnostic workup. Research design and methods. A total of 4196 PCHPs participated in 11 highly interactive 75-minute live conferences conducted throughout the US from 2011 through 2013 that featured case-based interactive discussions on the workup of microcytic, normocytic, and macrocytic anaemia by a PCHP and local haematologist expert. A standardised diagnostic algorithm for geriatric anaemia was used and distributed as a handout at the live activity. A reinforcing mobile application based on this algorithm was introduced in 2012. Main outcome measures. Data from participants were gathered immediately after the event, 10–12 weeks post-event, and 1–3 years post-event. Outcomes were evaluated according to Moore's levels. Chi-squared analyses compared the proportion of respondents who committed to one or more of the five major behavioural changes over time. Results. The Chi-squared test analysed data from each of the three timelines for five medical behavioural changes. A comparison of participants’ responses showed that there was a significant increase in the proportion of responders committing to behavioural change #1, “Avoid indiscriminant use of erythropoiesis-stimulating agents” and #5, “Refer patients with unexplained mild anaemia to a haematologist” from post-event to 1–3 years (p<0.001) (see Table 2). The proportion of respondents who committed to the other three behavioural changes remained consistent over time, suggesting that actual change in medical practice occurred at 1–3 years. Conclusions. This proof of concept study validates the use of case-based CME involving a highly interactive discussion between PCHP and specialist, used in conjunction with a standardised diagnostic algorithm as effective in improving PCHP knowledge, competence, and self-reported performance improvement. This study lays the groundwork for follow-up studies using objective performance measures.

Keywords

• CME
• impact
• change in practice behaviours