Brief reportsMulticomponent Internet continuing medical education to promote chlamydia screening
Introduction
The gap between routine medical care and best care has generated many studies on implementing best practices.1, 2, 3 Consequently, continuing medical education (CME) activities have been widely disseminated, with U.S. expenditures of >$1.3 billion dollars in 2002.4 However, the ineffectiveness of traditional CME in changing practice5 led the Institute of Medicine to suggest that the current CME system is “broken.”6
With the growing call for more experimental studies of “learning in practice” with clinically relevant outcomes,7 low screening rates for women at risk for Chlamydia trachomatis create a laboratory for testing innovative CME approaches. Despite cost-effective screening tests and treatments8, 9, 10, 11, 12, 13 and considerable attention from professional and regulatory organizations,14, 15 chlamydia screening rates remain unacceptably low.16, 17, 18, 19, 20, 21 For example, the average chlamydia screening rate for at-risk women aged 16 to 25 years reported by commercial managed care plans to the National Committee for Quality Assurance (NCQA) was 25% in 2002 and 30% in 2003.16
Chlamydia is the most commonly reported sexually transmitted disease, with reported rates increasing from 78.5 per 100,000 population to 455.4/100,000 between 1987 and 2002.22 Although most infections in women are asymptomatic,23 the risks of complications, such as pelvic inflammatory disease and ectopic pregnancy, are considerable.24 Therefore, a randomized trial was conducted in 20 states to test a multicomponent CME (mCME) intervention for increasing chlamydia screening for at-risk women in the managed care setting.
Section snippets
Overview
This study was funded by the Agency for Healthcare Research and Quality as part of the Translating Research into Practice (TRIP II) initiative.1 Primary care offices (n =191) participating in the study managed care organization were randomized to an intervention or comparison group (Table 1). Physicians in the intervention group received mCME modules and physicians in the comparison group received flat-text, Internet-based CME modules on women’s health. The main outcome was the
Results
Of all eligible offices (n =978), 325 (33%) were recruited (Figure 1, Phase I). From the recruited offices, 191 (59%) participated. Within participating offices, an average of 1.1 physicians engaged the study Internet site at least once (Table 1). Over the 1-year intervention period, the average physician completed 2.4 of 4 available modules. On average, each module required 12.3 (standard deviation, 9.2) minutes to complete. Office and physician characteristics did not differ significantly by
Discussion
This randomized trial demonstrated that an Internet CME program significantly blunted a decline in chlamydia screening rates observed in comparison offices. Because chlamydia is the most common bacterial STD, small increments in screening rates may detect large numbers of new cases.29 For example, the overall prevalence among females entering the National Job Training Program in 2002 was 10.5%.22 Given that urine screening tests operate with high sensitivity (93% to 99%) and specificity (96% to
Limitations
Additional limitations not mentioned elsewhere warrant discussion. First, this study did not examine changes in chlamydia detection rates, treatment rates, or patient outcomes. However, strong evidence links screening with improved outcomes. Second, recent studies suggest that the HEDIS measure may not be entirely accurate in determining chlamydia risk from administrative data44 or screening status from laboratory data.45 Third, Internet-based CME is more appealing to physicians with greater
Conclusion
This randomized trial of a multicomponent, Internet-based CME intervention found an attenuated decrease in screening rates for offices exposed to the intervention. The demonstrated impact on practice patterns coupled with low intervention intensity increases the potential importance of mCME as a learning method that is easy to disseminate. The appropriateness of mCME for other conditions and settings must be assessed.
References (46)
- et al.
Screening for chlamydial infection
Am J Prev Med
(2001) - et al.
Performance of Massachusetts HMOs in providing Pap smear and sexually transmitted disease screening to adolescent females
J Adolesc Health
(1998) - et al.
Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease
Am J Obstet Gynecol
(1997) - et al.
Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program
J Adolesc Health
(2001) - et al.
Understanding sexual activity defined in the HEDIS measure of screening young women for Chlamydia trachomatis
Jt Comm J Qual Improv
(2002) - et al.
Translating research into practicethe future ahead
Int J Qual Health Care
(2002) Improving the quality of medical carebuilding bridges among professional pride, payer profit, and patient satisfaction
JAMA
(2001)- et al.
Optimal methods for guideline implementationconclusions from Leeds Castle meeting
Med Care
(2001) Accreditation Council for Continuing Medical Education. ACCME annual report data 2002
(2003)- et al.
Impact of formal continuing medical educationdo conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
JAMA
(1999)
Health professions evaluationa bridge to quality
Learning in practicea new section in the BMJ. A place where educationalist and clinicians can exchange ideas
BMJ
Health and cost-benefits of chlamydia screening in young women
Sex Transm Dis
Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in womenimplications for a national chlamydia control strategy
Sex Transm Dis
Screening women for chlamydia trachomatis in family planning clinics
Sex Transm Dis
Cost effectiveness of screening for Chlamydia trachomatisa review of published studies
Sex Transm Infect
Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection
N Engl J Med
Guide to clinical preventive servicesreport of U.S. Preventive Services Task Force
Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993
MMWR Recomm Rep
The state of health care quality2004
Adolescent chlamydia testing practices and diagnosed infections in a large managed care organization
Sex Transm Dis
Adolescent health care providers
Sex Transm Dis
Asymptomatic sexually transmitted disease prevalence in four military populationsapplication of DNA amplification assays for chlamydia and gonorrhea screening
J Infect Dis
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