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Physician Knowledge (physician + knowledge)
Selected AbstractsThe Impact of a Brief Expectation Survey on Parental Satisfaction in the Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 12 2006Christopher D. Spahr MD Abstract Objectives To determine the effect of physician knowledge of parental expectations on satisfaction with emergency department (ED) care. Methods This was a prospective, controlled, interventional trial involving parents of children presenting to a children's hospital ED. Parents completed an expectation survey on arrival, which was either immediately placed back in the enrollment envelope (control) or shown to the physician caring for the child (intervention). The physician was instructed to initial the expectation survey to acknowledge receipt of the survey. Parents then completed a satisfaction survey at discharge. The primary outcomes were differences in satisfaction with physician review of the expectation survey, as measured by 1) parental ratings of overall care and 2) their willingness to recommend the ED to others. A third (baseline) group completed only a satisfaction survey at discharge. Results A total of 614 (66%) of the 930 enrolled parents completed the study. Intention-to-treat analysis did not show a significant increase in parental satisfaction ratings for either overall care or recommend the ED; however, only 42% of the intervention group surveys had documented physician review. When these initialed surveys were compared with the control group in a per-protocol analysis, there was a significant improvement in parental satisfaction. There were no differences between the control and baseline groups, indicating no effect of the expectation survey completion on satisfaction. Conclusions Physician knowledge of written parental expectations may improve parental satisfaction during an ED visit. Further work is needed to overcome the barriers to physician review of the expectation survey to maximize parent satisfaction. [source] Standardizing evaluation of on-line continuing medical education: Physician knowledge, attitudes, and reflection on practiceTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2004Associate Director, Dr. Linda Casebeer PhD Associate Professor Abstract Introduction: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses. Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later. Paired t tests were used to compare the means of responses across time. Results: U.S. physicians completed 720 post-tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatis-faction. Overall mean knowledge scores increased from 58.1% to 75.6% at post-test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case-based than for text-based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. Conclusions: Increases in physician knowledge and knowledge retention were demonstrated following participation in on-line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas. [source] The Impact of a Brief Expectation Survey on Parental Satisfaction in the Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 12 2006Christopher D. Spahr MD Abstract Objectives To determine the effect of physician knowledge of parental expectations on satisfaction with emergency department (ED) care. Methods This was a prospective, controlled, interventional trial involving parents of children presenting to a children's hospital ED. Parents completed an expectation survey on arrival, which was either immediately placed back in the enrollment envelope (control) or shown to the physician caring for the child (intervention). The physician was instructed to initial the expectation survey to acknowledge receipt of the survey. Parents then completed a satisfaction survey at discharge. The primary outcomes were differences in satisfaction with physician review of the expectation survey, as measured by 1) parental ratings of overall care and 2) their willingness to recommend the ED to others. A third (baseline) group completed only a satisfaction survey at discharge. Results A total of 614 (66%) of the 930 enrolled parents completed the study. Intention-to-treat analysis did not show a significant increase in parental satisfaction ratings for either overall care or recommend the ED; however, only 42% of the intervention group surveys had documented physician review. When these initialed surveys were compared with the control group in a per-protocol analysis, there was a significant improvement in parental satisfaction. There were no differences between the control and baseline groups, indicating no effect of the expectation survey completion on satisfaction. Conclusions Physician knowledge of written parental expectations may improve parental satisfaction during an ED visit. Further work is needed to overcome the barriers to physician review of the expectation survey to maximize parent satisfaction. [source] Primary care physician beliefs about insulin initiation in patients with type 2 diabetesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2008R. P. Hayes Summary Background:, Insulin is the most effective drug available to achieve glycaemic goals in patients with type 2 diabetes. Yet, there is reluctance among physicians, specifically primary care physicians (PCPs) in the USA, to initiate insulin therapy in these patients. Aims:, To describe PCPs' attitudes about the initiation of insulin in patients with type 2 diabetes and identify areas in which there is a clear lack of consensus. Methods:, Primary care physicians practicing in the USA, seeing 10 or more patients with type 2 diabetes per week, and having > 3 years of clinical practice were surveyed via an internet site. The survey was developed through literature review, qualitative study and expert panel. Results:, Primary care physicians (n = 505, mean age = 46 years, 81% male, 62% with > 10 years practice; 52% internal medicine) showed greatest consensus on attitudes regarding risk/benefits of insulin therapy, positive experiences of patients on insulin and patient fears or concerns about initiating insulin. Clear lack of consensus was seen in attitudes about the metabolic effects of insulin, need for insulin therapy, adequacy of self-monitoring blood glucose, time needed for training and potential for hypoglycaemia in elderly patients. Conclusions:, The beliefs of some PCPs are inconsistent with their diabetes treatment goals (HbA1c , 7%). Continuing medical education programmes that focus on increasing primary care physician knowledge about the progression of diabetes, the physiological effects of insulin, and tools for successfully initiating insulin in patients with type 2 diabetes are needed. [source] Improving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care ProvidersACADEMIC EMERGENCY MEDICINE, Issue 2 2010Amanda S. Newton PhD Abstract Objectives:, This systematic review evaluated the effectiveness of professional and organizational interventions aimed at improving medical processes, such as documentation or clinical assessments by health care providers, in the care of pediatric emergency department (ED) patients where abuse was suspected. Methods:, A search of electronic databases, references, key journals, and conference proceedings was conducted and primary authors were contacted. Studies whose purpose was to evaluate a strategy aimed at improving ED clinical care of suspected abuse were included. Study methodologic quality was assessed by two independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Results:, Six studies met the inclusion criteria: one randomized controlled trial (RCT), one quasi-RCT, and four observational studies. Study quality ranged from modest (observational studies) to good (trials). Variation in study interventions and outcomes limited between-study comparisons. The quasi-RCT supported self-instructional education kits as a means to improve physician knowledge for both physical abuse (mean ± standard deviation [SD] pretest score = 13.12 ± 2.36; mean ± SD posttest score = 18.16 ± 1.64) and sexual abuse (mean ± SD pretest score = 10.81 ± 3.20; mean ± SD posttest score = 18.45 ± 1.79). Modest-quality observational studies evaluated reminder systems for physician documentation with similar results across studies. Compared to standard practice, chart checklists paired with an educational program increased physician consideration of nonaccidental burns in burn cases (59% increase), documentation of time of injury (36% increase), and documentation of consistency (53% increase) and compatibility (55% increase) of reported histories. Decisional flow charts for suspected physical abuse also increased documentation of nonaccidental physical injury (69.5% increase; p < 0.0001) and had a similar significant effect as checklists on increasing documentation of history consistency and compatibility (69.5 and 70.0% increases, respectively; p < 0.0001) when compared to standard practice. No improvements were noted in these studies for documentation of consultations or current status with child protective services. The introduction of a specialized team and crisis center to standardize practice had little effect on physician documentation, but did increase documentation of child protective services involvement (22.7% increase; p < 0.005) and discharge status (23.7% increase; p < 0.02). Referral to social services increased in one study following the introduction of a chart checklist (8.6% increase; p = 0.018). A recently conducted multisite RCT did not support observational findings, reporting no significant effect of educational sessions and/or a chart checklist on ED practices. Conclusions:, The small number of studies identified in this review highlights the need for future quality studies that address care of a vulnerable clinical population. While moderate-quality observational studies suggest that education and reminder systems increase clinical knowledge and documentation, these findings are not supported by a multisite randomized trial. The limited theoretical base for conceptualizing change in health care providers and the influence of the ED environment on clinical practice are limitations to this current evidence base. ACADEMIC EMERGENCY MEDICINE 2010; 17:117,125 © 2010 by the Society for Academic Emergency Medicine [source] Standardizing evaluation of on-line continuing medical education: Physician knowledge, attitudes, and reflection on practiceTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2004Associate Director, Dr. Linda Casebeer PhD Associate Professor Abstract Introduction: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses. Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later. Paired t tests were used to compare the means of responses across time. Results: U.S. physicians completed 720 post-tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatis-faction. Overall mean knowledge scores increased from 58.1% to 75.6% at post-test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case-based than for text-based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. Conclusions: Increases in physician knowledge and knowledge retention were demonstrated following participation in on-line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas. [source] Outcome research in diabetes: from theory to practice.DRUG DEVELOPMENT RESEARCH, Issue 3 2006Results of the QuED study Abstract Despite the fact that several pharmacological and educational interventions have been proven to improve diabetes outcomes in the context of randomized clinical trials, the transferability of these results to clinical practice can encounter obstacles represented by physicians' knowledge and beliefs, structural and organizational constraints, and patients' clinical and socio-economical characteristics. Outcomes research represents a fundamental tool to investigate the extent to which trials results can be reproduced under routine clinical conditions, to evaluate clinical behavior in areas of uncertainty, and to ascertain which features of diabetes care are more important to improve clinical outcomes and quality of life. This report will discuss some of the results of the QuED (Quality of Care and Outcomes in Type 2 Diabetes) study, to exemplify the yield of an outcomes research approach to a complex, chronic disease. The QuED Study is a nation-wide initiative aimed at assessing the relationship between the quality of care delivered to subjects with type 2 diabetes and outcomes. The study involved 101 outpatient diabetes clinics and 103 General Practitioners (GPs) in Italy. Overall, 3,437 patients have been enrolled and followed up for 5 years at 6-month intervals. Quality of life was evaluated through questionnaires filled in by the patients at 6-month intervals for 3 years. A physicians' survey was also conducted to investigate physician's beliefs regarding metabolic control, blood pressure, and lipid control. Given the multiplicity of the sources of information, the study allowed for matching physicians' beliefs and practices with intermediate and long-term clinical and humanistic outcomes. Drug Dev. Res. 67:280,286, 2006. © 2006 Wiley-Liss, Inc. [source] Anabolic steroid users' attitudes towards physiciansADDICTION, Issue 9 2004Harrison G. Pope ABSTRACT Aims To assess anabolic-androgenic steroid (AAS) users' trust in the knowledge and advice of physicians. Design Interviews of AAS users and non-users. Setting Research offices. Participants Eighty weight-lifters (43 AAS users, 37 non-users) recruited by advertisement in Massachusetts and Florida, USA. Measurements Personal interviews and questionnaire responses, including subjects' ratings of physicians' knowledge regarding various health- and drug-related topics. AAS users also rated their level of trust in various sources of information about AAS. Findings Both groups of subjects gave physicians high ratings on knowledge about general health, cigarette smoking, alcohol, and conventional illicit drugs, but gave physicians markedly and significantly lower ratings on knowledge about AAS. When rating sources of information on AAS, users scored physicians as no more reliable than their friends, Internet sites, or the person(s) who sold them the steroids. Forty percent of users trusted information on AAS from their drug dealers at least as much as information from any physician that they had seen, and 56% had never revealed their AAS use to any physician. Conclusion AAS users show little trust in physicians' knowledge about AAS, and often do not disclose their AAS use to physicians. These attitudes compromise physicians' ability to educate or treat AAS users. Physicians can respond to these problems by learning more about AAS and by maintaining a high index of suspicion when evaluating athletic male patients. [source] Does patient partnership in continuing medical education (CME) improve the outcome in osteoporosis management?THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2002Dr. Mahmood Puzirandeh MD FACP Director Abstract Introduction: There is an apparent gap between physicians' knowledge and their practical application of such knowledge. Educating patients to educate physicians toward improved care has been shown to be effective in selected settings. This study describes the influence of an active community education program on changing physician behavior. Methods: A total of 672 schoolteachers were interviewed and screened for detection of osteoporosis risk factors. The teachers were educated about osteoporosis and the significance of bone mass densitometry (BMD) in its management and returned to their physicians with the results of their screening. One group of their physicians received didactic lectures on the results of the screening and the impact of appropriate management on the outcome of osteoporosis. The second group of physicians did not. Six months after the initial interview and screening, patients received a mailed survey. Results: After 6 months, 258 of the teachers who had visited their physicians were resurveyed. The percentage of BMD tests ordered by physicians rose form 8.6% to 33% in both the intervention and control physician groups. Findings at the 6-month survey indicated that physicians initiated the osteoporosis discussion an average of 18% of the visits and patients did an average of 60%, prompting the physician to order a BMD test. Discussion: In this study, there was no evidence that didactic lectures affect physician behavior in ordering BMD. There were, however, compelling indications that patient education, which included written screening results, enhanced physician-patient diaglogue, resulting in more BMD orders. [source] | ||||||||||