Bernd Hagen

Time course of change in prescription behaviour after targeted continuing medical education in a closed loop system of repeated standardised documentation and feedback

Objective. This study investigates whether introducing targeted CME into a regular feedback system being part of a disease management programme (DMP) will improve prescription behaviour, and if yes, how long it will take to demonstrate this effect and what could be the magnitude of such an effect. Methods. From the database of the DMP coronary artery disease (CAD) in the two German regions of North Rhine (NR) and Westphalia Lippe (WL), respectively, all patients with heart failure in New York Heart Association (NYHA) class II and III were extracted. Prescription of combination therapy (ACE inhibitor, ACE-I, and beta blocker, BB), as recommended by the guidelines, was prospectively monitored for 6 years after this topic was addressed in a series of accredited CME modules. These modules were part of extended feedback reports for NR physicians, while physicians in WL received basic feedback reports only. Data were analysed according to participants vs. non-participants in CME vs. control group (WL). Results. The largest increase was observed with regard to the additional prescription of an ACE-I in patients who only received a BB at baseline. BB prescription rates increased to a lesser extent. But for both drugs, prescription rates did not reach their maximum even at the end of the 6 years’ observation period. Significant differences in prescription rates in favour of patients of CME participants could only be demonstrated after 3 years from the first CME article. Conclusions. The DMP CAD has to be considered as a multifaceted intervention which significantly changes prescription behaviour. Combination of the DMP with a further multifaceted intervention (print CME) added only little to this effect. The time course of change makes it difficult exclusively to relate the observed changes in prescription rates to the CME intervention.