Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-19T02:07:09.215Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews

Published online by Cambridge University Press:  04 August 2005

Bernard S. Bloom
Bernard S. Bloom
Affiliation:
University of Pennsylvania
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The objective of physician continuing medical education (CME) is to help them keep abreast of advances in patient care, to accept new more-beneficial care, and discontinue use of existing lower-benefit diagnostic and therapeutic interventions. The goal of this review was to examine effectiveness of current CME tools and techniques in changing physician clinical practices and improving patient health outcomes.

Methods: Results of published systematic reviews were examined to determine the spectrum from most- to least-effective CME techniques. We searched multiple databases, from 1 January 1984 to 30 October 2004, for English-language, peer-reviewed meta-analyses and other systematic reviews of CME programs that alter physician behavior and/or patient outcomes.

Results: Twenty-six reviews met inclusion criteria, that is, were either formal meta-analyses or other systematic reviews. Interactive techniques (audit/feedback, academic detailing/outreach, and reminders) are the most effective at simultaneously changing physician care and patient outcomes. Clinical practice guidelines and opinion leaders are less effective. Didactic presentations and distributing printed information only have little or no beneficial effect in changing physician practice.

Conclusions: Even though the most-effective CME techniques have been proven, use of least-effective ones predominates. Such use of ineffective CME likely reduces patient care quality and raises costs for all, the worst of both worlds.

Keywords

Medical educationClinical practicePopulation healthPhysician educationContinuing medical educationEvidence-based medicine
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 3 , July 2005 , pp. 380 - 385
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Austin SM, Balas EA, Mitchell JA, Ewigman BG. 1994; Effect of physician reminders on preventive care: Meta-analysis of randomized clinical trials. Proceedings—the Annual Symposium on Computer Applications in Medical Care 120: 121– 124.Google Scholar
Balas EA, Austin Boren S, Brown GD, et al. 1996 Effect of physician profiling on utilization: Meta-analysis of randomized clinical trials. J Gen Intern Med. 11: 584– 590.Google Scholar
Berger ML, Nebenfuhr P, Murray RK. 2000 The value of disease management—approaching the industrialisation of modern medicine. Dis Manage Health Outcomes. 8: 181– 184.Google Scholar
Bero LA, Grilli R, Grimshaw JM, et al. 1998 Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 317: 465– 468.Google Scholar
Bloom BS, Smith WP, Weitz D, LaMont B. 1997 The diagnostic and treatment approach to two common conditions by the members of a community health maintenance organization. Am J Manage Care. 3: 733– 736.Google Scholar
Buntinx F, Winkins R, Grol R, Knotternerus JA. 1993 Influencing diagnostic and preventive performance in ambulatory care by feedback and reminders. A review. Fam Pract. 10: 219– 228.Google Scholar
Chassin MR, Korsecoff JB, Park RE, et al. 1987 Does inappropriate use explain geographic variations in the use of health services? A study of three procedures. JAMA. 258: 2533– 2537.Google Scholar
Davis D, O'Brien MA, Freemantle N, et al. 1999 Impact of formal continuing medical education: Do conferences, workshops, rounds, and other continuing education activities change physician behavior or health care outcomes? JAMA. 282: 867– 874.Google Scholar
Davis DA, Taylor-Vaisey A. 1995; Translating guidelines into practice: A systematic review of theoretic concepts and research evidence in the adoption of clinical practice guidelines. CMAJ 157: 408– 416.Google Scholar
Davis DA, Thomson MA, Oxman AD, Haynes RB. 1995 Changing physician performance: A systematic review of the effect of continuing medical education strategies. JAMA. 274: 700– 705.Google Scholar
Fendrick AM, Ridker PM, Bloom BS. 1994 Improved health benefits of increased use of thrombolytic therapy. Arch Intern Med. 154: 1605– 1609.Google Scholar
Fendrick AM, Smith DG, Chernew ME, Shah SN. 2001 A benefit-based co-pay for prescription drugs: Patient contribution based on total benefits, not drug acquisition cost. Am J Manage Care. 7: 861– 867.Google Scholar
Freemantle N, Harvey EL, Wolf F, et al. 2000 Printed educational materials: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD000172.Google Scholar
Grimshaw J, Freemantle N, Wallace S, et al. 1994 Developing and implementing clinical practice guidelines. Qual Health Care. 4: 55– 64.Google Scholar
Grimshaw JM, Thomas RE, MacLennan G, et al. 2004 Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 8: iii–iv 1– 72.Google Scholar
Grol R. 2001 Improving the quality of medical care: Building bridges among professional pride, payer profit and patient satisfaction. JAMA. 286: 2578– 2585.Google Scholar
Haynes RB, Davis DA, McKibbon A, Tugwell P. 1984 A critical appraisal of the efficacy of continuing medical education. JAMA. 251: 61– 64.Google Scholar
Heffler S, Levit K, Smith S, et al. 2001 Health spending growth up in 1999; Faster growth expected in the future. Health Aff (Millwood). 20: 193– 203.Google Scholar
Hellinger FJ. 1996 The impact of financial incentives on physician behavior in managed care plans: A review of the evidence. Med Care Res Rev. 53: 294– 314.Google Scholar
Ibrahim SA, Kwoh CK. 2000 Underutilization of oral anticoagulant therapy for stroke prevention in elderly patients with heart failure. Am Heart J. 140: 219– 220.Google Scholar
Institute of Medicine. 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press;
Institute of Medicine. 2000. To err is human: Building a safer health system. In: Kohn LT, Corrigan JM, Donaldson MS, eds. Washington, DC: National Academy Press;
Johnston ME, Langton KB, Haynes RB, Mathieu A. 1994 Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research. Ann Intern Med. 120: 135– 142.Google Scholar
Lomas J. 1988 Haynes RB. A taxonomy and critical review of tested strategies for the application of clinical practice recommendations: From “official” to “individual” clinical policy. Am J Prev Med. 4 (Suppl): 77– 94.Google Scholar
Mason J, Freemantle N, Nazareth I, et al. 2001 When is it cost-effective to change behavior of health professionals? JAMA. 286: 2988– 2992.Google Scholar
McGlynn EA, Asch SM, Adams J, et al. 2003 The quality of health care delivered to adults in the United States. N Engl J Med. 348: 2635– 2645.Google Scholar
Miller NF. 1946 Hysterectomy: Therapeutic necessity or surgical racket. Am J Obstet Gynecol. 51: 804– 810.Google Scholar
Morrison A, Wertheimer AI, Berger ML. 2000 Interventions to improve antihypertensive drug adherence: A quantitative review of trials. Formulary. 35: 234– 255.Google Scholar
Oxman AD, Thomson MA, Davis DA, Haynes RB. 1995; No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. CMAJ 153: 1423– 1431.Google Scholar
Peterson OL, Andrews LP, Spain RS, Greenberg BG. 1956 An analytical study of North Carolina general practice. J Med Education. (Pt 2): 1– 165.Google Scholar
Shea S, DuMouchel W, Bahamonde L. 1996 A meta-analysis of 16 randomized control trials to evaluate computer-based clinical reminder systems in preventive care in ambulatory settings. J Am Inform Assoc. 3: 399– 409.Google Scholar
Silagy C, Lancaster T, Fowler G. 1994 Effectiveness of training health professionals to provide smoking cessation interventions: Systematic review of randomised controlled trials. Qual Health Care. 3: 193– 198.Google Scholar
Soumerai SB, McLaughlin TJ, Avorn J. 1990 Quality assurance for drug prescribing. Qual Assur Health Care. 2: 37– 58.Google Scholar
Stone EG, Morton SC, Hulscher ME, et al. 2002 Interventions that increase use of adult immunizations and cancer screening services. Ann Intern Med. 136: 641– 651.Google Scholar
Thomson O'Brien MA, Oxman AD, Davis DA, et al. 2000 Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD000259.Google Scholar
Thomson O'Brien MA, Freemantle N, Oxman AD, et al. 2001 Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD003030.Google Scholar
Thomson O'Brien MA, Oxman AD, Davis DA, et al. 2000 Educational outreach visits: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD000409.Google Scholar
Thomson O'Brien MA, Oxman AD, Haynes RB, et al. 2000 Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. (2): CD000125.Google Scholar
Walton RT, Harvey E, Dovey S, Freemantle N. 2001 Computerised advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev. (1): CD002894.Google Scholar
Wensing M, Grol R. 1994 Single and combined strategies for implementing changes in primary care: A literature review. Int J Qual Health Care. 6: 115– 132.Google Scholar
Yano EM, Fink A, Hirsch SH, Robbins AS, Rubinstein LV. 1995 Helping practices reach primary care goals: Lessons from the literature. Arch Intern Med. 155: 1146– 1156.Google Scholar