Physician assessments of the value of therapeutic information delivered via e-mail

Program description

This CME program was implemented in the context of a funded study that used a participatory research approach with the Canadian Pharmacists Association and the CFPC. Beginning in early 2010, the Canadian Pharmacists Association delivered weekly Highlights via e-mail to CFPC members. Information for Highlights was gathered from e-Therapeutics+,⁴ the online version of the book Therapeutic Choices⁵ published by the Canadian Pharmacists Association. On viewing the Highlights e-mail, participants had access to the chapter of e-Therapeutics+ from which the information was derived. Chapter access was granted for 2 months from the date the Highlights e-mail was sent. Highlights were linked to the IAM so that participants could document their reflective learning.

The e-T Highlights were chosen for this program by clinical editors at the Canadian Pharmacists Association and vetted by 1 CFPC member (co-author B.M.) before dissemination. Beginning January 20, 2010, all CFPC members with valid e-mail addresses received a weekly invitation to participate in rating that week’s Highlight. Members of the CFPC who accepted the invitation completed a short demographic survey after clicking on the Earn Mainpro Credits button adjacent to the first Highlight they read. This was followed by their first IAM questionnaire, which asked participants to indicate whether that particular Highlight had an effect on them or their practice (yes, no, possibly) and whether that Highlight was relevant for at least 1 of their patients. With each subsequent Highlight that was read, only the IAM questionnaire was presented. For each submitted IAM questionnaire, family physicians earned 0.1 Mainpro-M1 credits, following a process similar to that used for other e-learning programs.⁶

One Highlight was delivered weekly to 17 000 e-mail addresses (each address belonging to 1 CFPC member). To read the Highlight embedded within its e-Therapeutics+ chapter, participants had to open the e-mail and click on the hyperlinked Highlight title. Data collection ran from January 20 to December 31, 2010. Data from the demographic characteristics questionnaire and the Highlights ratings completed with the IAM were analyzed descriptively.

A total of 5346 CFPC members completed the demographic characteristics questionnaire and submitted at least 1 rating of a Highlight. The participation rate was 31% (5346 of 17 000). Ninety-one percent of participants reported they were in family or general practice, while 85% were in full-time or part-time practice. Slightly more than half of participants were women (53%), and 56% of participants were CFPC Certificants.

There were 31 429 ratings of 49 Highlights in 2010, for an average of 667 ratings per Highlight (range 415 to 1176). The median number of Highlight ratings per participant was 2 (range 1 to 49). Among CFPC members who submitted more than 2 ratings, the median number of ratings per participant was 7 (mean 11.9).

Participants believed the clinical information from e-T Highlights was totally or partially relevant for at least 1 patient 90% of the time. To understand which Highlights were most or least relevant according to CFPC members, we calculated a relevance statistic that ranged from 0 to 1, called the clinical relevance of information index. The clinical relevance of information index value ranged from 0.458 to 0.899 per Highlight (mean 0.713). The following 2 Highlights had the lowest and the highest relevance rating, respectively:

• Tizanidine is a good first-line treatment, or it can be combined with baclofen, as they have different sites of action.

• Penicillin is the drug of choice for streptococcal sore throat. Although cephalosporins are effective, they should not replace penicillin as the drug of choice.

With regard to knowledge translation, for 59% of the rated Highlights, participants said the information would be used for at least 1 patient. For 41% of the rated Highlights, participants expected patient health benefits owing to Highlight recommendations, such as avoiding an unnecessary or inappropriate treatment, or a preventive intervention (Figure 1).

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Figure 1.

Value of the information from e-Therapeutics Highlights

Limitations

Our data are self-reported. As such, the health benefits for specific patients were “expected” and not objectively documented. Whether patient health outcomes are influenced by the push of clinical information from one electronic knowledge resource is an open question for future research. In addition, we did not measure how frequently Highlights were read and not rated. If Highlights are more likely to be rated by family physicians when they are relevant for at least 1 patient, then our data overestimate the clinical relevance of each Highlight.

Continuing medical education programs do not randomly select participants. Therefore, physicians in this program were more motivated to receive e-mail alerts, as well as read and rate Highlights. Nevertheless, knowledge that the Highlights program might lead to health benefits for specific patients is potentially important to improving the outcomes of clinical practice. Given these expected benefits for patients, the Highlights e-learning program has been sustained by the Canadian Pharmacists Association and the CFPC. In addition, a new program for Canadian pharmacists—mirroring the current program for family physicians—was launched by the Canadian Pharmacists Association in 2012. The continuation of this program opens the door to further research, as ratings are subjective physician experiences that might be objectively confirmed.