Individualized provider learning programs such as opinion leader and pharmaceutical detailing improve care but are expensive and difficult to standardize. Alternative methods to deliver continuing medical education (CME) tailored to the needs of individual physicians are desirable. The purpose of this study was to assess the impact of an individualized case-based learning intervention on the care provided by primary care physicians (PCPs) to actual patients with diabetes.
Eleven clinics with 41 consenting PCPs were randomized to receive or not receive the learning intervention. The trial was conducted from October 2006 to May 2007. A personalized set of 12 simulated type 2 diabetes learning cases was assigned to each intervention group PCP. Cases were designed to remedy specific deficits found in physician electronic medical record (EMR) observed practice patterns. Each case took 15-20 minutes to complete; most cases were completed within one week.
Change from pre-intervention to 12 month post-intervention levels of glycated hemoglobin (A1c), blood pressure (BP) and LDL-Cholesterol (LDL) were assessed with general linear mixed models to reflect clinic-level randomization. Generalized linear models analyzed differences by study arm in the total of intervention and health care costs. Intervention effects were also assessed separately in patients who did and did not use insulin.
Intervention clinic patients with baseline A1c >=7% had significantly better A1c reduction (intervention effect -0.19%, p=.034) with a trend toward lower cost per patient -$71 (SE=142, p=.63) relative to non-intervention clinic patients. A1c reductions were comparable among patients using insulin (intervention effect -0.18%) and those not (-0.22%). The intervention did not significantly improve BP or LDL control. Additional models adjusting for age, gender, and comorbidity showed similar results. PCPs reported high satisfaction with the learning intervention.
A brief individualized case-based simulated learning intervention for primary care physicians led to modest but significant improvement in glucose control in adults with type 2 diabetes without increasing costs.