Research Question: Can continuing medical education in combination with process improvement methods improve the delivery of preventive care to children?

 

Article: Practice based education to improve delivery systems for prevention in primary care: randomised trial. Margolis PA, Lannon CM, Stuart JM, Fried BJ, Keyes-Elstein L, Moore Jr DE. BMJ 2004; 328(7436):388. Full-Text

 

Summary:

A randomized trial was performed with 44 private pediatric and family practices to test the effectiveness of an ‘office system’ to improve immunizations and screening for anemia, lead, and tuberculosis. The intervention involved monthly meetings between project staff (trained nurse and physician) and newly formed practice improvement teams (clerical, nursing, and physician staff members) over the course of a year. During this time, they reviewed medical records and practice performance, identified evidence based delivery strategies and tools for preventive services, performed small scale tests to try out changes, and fully implemented successful care processes. In the second year, project staff followed-up by telephone every two to three months to discuss problems and offer support. All practices received publicly available materials designed to facilitate preventive care. Thirty months after baseline, the proportion of children who were up to date with preventive services was higher in intervention than control practices; results for screening for tuberculosis, lead, and anemia were statistically significant. 

 

Implications:

1.      Interventions that facilitate the integration of evidence-based medicine into the way that care is delivered in the practice setting improved delivery of preventive care in this study.

2.      Further work is needed to develop ways of improving the efficiency and cost of facilitating office system changes.  

 

Further reading:

1.      Preschool vision screening frequency after an office-based training session for primary care staff. Hered RW, Rothstein M. Pediatrics 2003;112(1 Pt 1):e17-21. PubMed Abstract

2.      Addressing barriers to change: an RCT of practice-based education to improve the management of hypertension in the elderly. Cranney M, Barton S, Walley T. Br J Gen Pract 1999;49(444):522-6. PubMed Abstract

 

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Keywords to use: family practice AND preventive medicine

 

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Research Digest is compiled by Joanne Goldman and Laure Perrier of the Knowledge Translation Program at the University of Toronto (www.ktp.utoronto.ca). Its goals are to highlight and summarize recent publications, stimulate discussion and reading, and generate research in the subject area.