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W. B. Rafferty, P. Lee, D. Lobach, G. McGwin, L. Branch, M. Hunt, E. Postel, P. Mruthyunjaya; One-Year Changes in Diabetes Knowledge Among Providers After Interventions to Improve Care. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4986.
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Prior work has shown that important opportunities exist to enhance the knowledge of diabetes related eye disease and care among primary eye care providers (optometrists and non-retina specialist ophthalmologists). We previously demonstrated modest improvements in knowledge in the short term (3 to 8 months) after a continued education (CME) course and the initiation of interventions to enhance diabetes related eye care. We sought to assess the longer-term impact of CME and interventions at one year to determine the efficacy of such intervention in improving knowledge.
Participating providers were randomized to one of 3 groups: 1) CME only; 2) CME plus a templated written exam form and office poster (low technology) and 3) CME plus a tablet computer with a decision support system (high technology). At one year, all participants received an updated CME course together with a written survey, with all versions of the survey psychometrically balanced based on the results of earlier studies. The changes in each of the 3 groups was assessed using linear regression, controlling for the scores at baseline.
Scores from 82 assessments show that no significant changes in scores (0 to 100 scale) occurred between arms at one year (12 to 16 months after baseline) in 10 of 12 domains and in none of the 5 critical domains previously identified (a - recognition of disease findings; b - benefits of eye treatment; c- components and intervals for exams; d - the natural history of untreated diabetes eye disease; and e - the indications and contraindications for treatment).
As noted in other studies, non-interactive CME alone has little impact on provider knowledge and skills. Use of interventions during the year, while potentially helpful in the short term did not have an enduring impact, even with the provision of an additional CME course at one year. Thus, alternative avenues to traditional educational means need to be aggressively assessed. In addition, better understanding the link as to whether and how changes in provider knowledge will translate into improved patient care will be critical in improving care.
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