Short-Term Changes in Diabetes Knowledge Among Providers After Interventions to Improve Care

Abstract

Purpose:: Prior work has demonstrated that important opportunities exist to assist primary eye care providers (optometrists and comprehensive ophthalmologists) in understanding and applying best-evidence care for their patients with diabetes and diabetic retinopathy. We sought to assess the short-term (3 months - 8 months) impact of interventions to enhance care across 3 groups - 1) CME course 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).

Methods:: Participating providers completed an instrument that had been psychometrically balanced with a baseline survey 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 prior to the interventions.

Results:: Scores from the first 60 of 96 provider assessments showed that no changes occurred in the group receiving CME only for 5 critical domains of care: a) recognition of diabetic eye disease findings; b) benefits of treatment of diabetic eye disease; c) components and intervals for exams; d) the natural history of untreated diabetic eye disease; and e) the indications and contraindications for treatment. There was improvement by at least 5 to 7 points (out of 100) for the recognition of diabetic eye disease findings and exam components and intervals in the two intervention groups.

Conclusions:: As noted in other studies, non-interactive CME alone has little impact on provider knowledge and skills. Use of interventions to improve the process quality of care may result in modest improvements in knowledge and skill for certain critical elements of care. Additional investigation of longer-term impacts and more detailed analyses will be critical to understanding how to improve patient care and patient outcomes.

Keywords: diabetes • diabetic retinopathy • clinical (human) or epidemiologic studies: health care delivery/economics/manpower