EDUCATIONAL NEEDS ADDRESSED

Physicians in solo and small-group practices, due to financial constraints and relentless patient care demands, experience barriers to accessing professional development programs essential for maintaining high standards of clinical care and patient safety.  A high-quality, internet-based, interactive CME program may address some of the educational inadequacies, and meet the needs of solo and small-group practice clinicians in providing improved practice performance and patient care. [1]

Specific issues to be addressed can be categorized under three broad headings:  patient safety as affected by office systems, patient safety as a result of appropriate and timely cancer screenings, and quality of care of patients with chronic illnesses.

Medical Error

Reduction of medical errors has become a national health care priority primarily in response to the IOM report on this topic. [2]   Although medical error in the ambulatory setting represents a significant proportion of all errors, [3] current efforts to reduce preventable medical errors (PME) remain most focused on the inpatient setting.  Primary care office visits are plagued with missing clinical information, and other office administrative errors, [4] likely to adversely affect patients. [5]   In fact, filing system errors [6] and inadequate reminder systems [7] are among the types of errors most commonly reported in US primary care practices.

Cancer Screening

All primary care and GI specialty organizations recommend screening for colorectal cancer. However, patient uptake of screening is limited. It has been estimated that if current screening methods were fully utilized, the death rate from colorectal cancer would drop by 50%. [8]   Lack of physician recommendation is an important factor in low screening rates [9] and clinician recommendation is the best predictor of screening.  Patient reluctance for screening can be mitigated through effective interpersonal communication methods that can be taught to PCPs. [10]  

Chronic Disease Management

Chronic illnesses are the most commonly managed condition by primary care physicians yet most physicians report that their training in chronic disease was inadequate. [11]  Strategies effective in changing physician behavior and improving patient outcomes include those using multiple interventions including clinical education, audit/feedback, reminder systems, enhanced role of nurses (care management), and greater coordination between primary and secondary care (consultants). [12] [13]   These activities are included in the Chronic Disease Model. [14]   It recognizes that suboptimal outcomes result from: rushed practitioners not following established practice guidelines; lack of care coordination; and lack of active follow-up to ensure the best outcomes.13 


[1] Marinopoulos, S.S., et al., Effectiveness of Continuing Medical Education.  2007, AHRQ Publication No. 07-E006.

[2] Institute of Medicine. To Err is Human: Building a Safer Health System. 2000, IOM.: Washington, DC.

[3] Weingart, S.N., et al., Epidemiology of medical error. BMJ, 2000. 320(7237): p. 774-7.

[4] Davenport, J., Documenting High-Risk Cases to Avoid Malpractice Liability. Fam Prac Management, 2000. 7(9): p. 33-36.

[5] Smith, P.C., et al., Missing clinical information during primary care visits. JAMA, 2005. 293(5): p. 565-71.

[6] Dovey, S.M., et al., Types of medical errors commonly reported by family physicians. Am Fam Physician, 2003. 67(4): p. 697.

[7] Woolf, S.H., et al., A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med, 2004. 2(4): p. 317-26.

[8] Hosemann, S., http://www2.mdanderson.org/depts/oncolog/articles/04/2-feb/2-04-1.html. Accessed May 22, 2006.

[9] Klabunde, C.N., A.P. Schenck, and W.W. Davis, Barriers to colorectal cancer screening among Medicare consumers. Am J Prev Med, 2006. 30(4): p. 313-9.

[10] Denberg, T.D., et al., Predictors of nonadherence to screening colonoscopy. J Gen Intern Med, 2005. 20(11): p. 989-95.

[11] Darer, J.D., et al., More training needed in chronic care: a survey of US physicians. Acad Med, 2004. 79(6): p. 541-8.

[12] Gilbody, S., et al., Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA, 2003. 289(23): p. 3145-51.

[13] Cauffman, J.G., et al., Randomized controlled trials of continuing medical education: what makes them most effective? J Contin Educ Health Prof, 2002. 22(4): p. 214-21.

[14] Wagner, E.H., http://www.improvingchroniccare.org/index.html. Accessed May 10, 2006.