title: Teleconferenced educational detailing: diabetes education for primary care physicians.
abstract: BACKGROUND
  Formal didactic continuing medical education (CME) is relatively ineffective for changing physician behaviour. Diabetes mellitus is an increasingly prevalent disease, and interventions to improve adherence to clinical practice guidelines (CPGs) are needed.
  
  
  METHODS
  A stratified, cluster-randomized, controlled trial design was used to evaluate the effects of a teleconferenced educational detailing (TED) CME on glycemic control (hemoglobin [Hb] A1c) and family physician adherence to national diabetes guidelines. TED employed sequential, small-group, case-based education using CPGs delivered by a diabetes specialist. Medical record audit data from baseline through the end of a 12-month postintervention period were compared for the control and intervention groups. Satisfaction with the intervention was evaluated.
  
  
  RESULTS
  Sixty-one physicians provided 660 medical records. The intervention did not affect mean Hb A1c levels but did significantly (p = .04) alter the distribution of patients by category of glycemic control, with fewer in the intervention group in inadequate control (15.8% versus 23.9%). More patients took insulin (alone or with oral agents) in the intervention group (21.2% versus 12.0%, p = .03), and more took oral agents only in the control group (89.0% versus 82.9%, p = .005). More patients in the intervention group had documentation of body mass index (7.8% versus 1.9%, p < .02), eye exam (12.1% versus 5.1%, p = .02), and treatment plan (43.5% versus 23.6%, p = .01) and used a flow sheet (14.6% versus 7.7%, p < .03). Although there was general satisfaction with the teleconferencing format, specialist educators found the format more challenging than the family physicians.
  
  
  CONCLUSIONS
  CME delivered by teleconference was feasible, well attended, well received by participants, and improved some key diabetes management practices and outcomes.
authors.affiliation: Department of Family Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada. sharris1@uwo.ca
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: Susan
authors.initials: S
authors.lastname: Webster-Bogaert
authors.forename: Daphne M
authors.initials: DM
authors.lastname: Van
authors.forename: Colleen
authors.initials: C
authors.lastname: O'Neill
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians'; D013685:Telecommunications; D014481:United States