Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension.
BACKGROUND
As expectations for effective continuing medical education (CME) grow, so, too, does the need to identify relationships among educational methods, physician performance, and patient outcomes associated with specific disease entities. Thus, we set out to review the literature on the effectiveness of physician educational interventions in the management and follow-up of hypertension.


METHODS
We searched PubMed and the Research and Development Resource Base in Continuing Medical Education for randomized controlled trials of physician educational interventions. We included only those studies that (a) used replicable educational interventions with > 50% physician involvement and that employed objective methods to measure physician behavior change or patient outcomes, (b) indicated a physician or patient dropout rate of < 30%, and (c) followed outcome measurement for > 30 days. Studies were designated "positive" if one or more of the primary outcome measures demonstrated a statistically significant change in physician performance or health care outcome.


RESULTS
We found 12 studies in which 7 different physician educational interventions were employed, alone or in combination, including reminders (computer or chart), formal CME, computerized decision support systems/risk stratification, printed educational materials, academic detailing, continuous quality improvement projects, and disease management aids in patient charts. Of the 12, 7 were positive and 4 were negative. One had mixed results.


CONCLUSIONS
Although physician educational interventions, especially reminders, improved the follow-up of hypertension, they were ineffective in changing blood pressure levels. However, they may have some utility in improving compliance with guideline recommendations.
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Karen
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Department of Family and Community Medicine, Family Healthcare Research Unit, Faculty of Medicine, University of Toronto, Institute for Clinical Evaluative Sciences, Toronto Western Hospital-University Health Network-Family Health Centre, Toronto, Ontario.
Davis
Dave
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D020000:Decision Support Systems, Clinical; D004502:Education, Medical, Continuing / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems; D017749:Total Quality Management