title: Improved cardiovascular prevention using best CME practices: a randomized trial.
abstract: BACKGROUND
  It was hypothesized that after a continuing medical education (CME) event, practice enablers and reinforcers addressing main clinical barriers to preventive care would be more effective in improving general practitioners' (GPs) adherence to cardiovascular guidelines than a CME event only.
  
  
  METHODS
  A cluster-randomized trial was conducted on a convenience sample of 122 GPs who were randomly assigned to either CME only (control group) or CME with practice enablers and reinforcers (PER group). In the PER group, nurses visited GPs' offices once a month to implement the clinical intervention on patients > or = 55 years old with a scheduled visit in the month following the nurse visit: (1) screening medical records for potentially undermanaged high-risk patients; (2) prompting physicians to reassess preventive care in these patients; (3) enclosing a checklist reporting most recent information relevant to guidelines' implementation; and (4) enclosing a summary of experts' recommendations in the form of a follow-up and treatment algorithm.
  
  
  RESULTS
  A retrospective chart audit of 2344 consenting patients, potentially undermanaged at baseline, demonstrated that the PER intervention following CME significantly improved adherence to guidelines compared to CME alone (OR: 1.78, 95% CI: 1.32-2.41).
  
  
  CONCLUSIONS
  The intervention was designed for self-implementation in primary care practices that have their own nursing staff. PER GPs were highly satisfied with the intervention; the majority said that they would implement it in their practice if someone trained their nurse, thus suggesting support for development of a multiprofessional CME program to disseminate this clinical approach to primary care practice groups.
authors.affiliation: Division of Continuing Professional Development, Faculty of Medicine, Université de Montréal, Montreal QC, Canada.
authors.forename: Réjean
authors.initials: R
authors.lastname: Laprise
authors.forename: Robert
authors.initials: R
authors.lastname: Thivierge
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gosselin
authors.forename: Maja
authors.initials: M
authors.lastname: Bujas-Bobanovic
authors.forename: Sylvie
authors.initials: S
authors.lastname: Vandal
authors.forename: Daniel
authors.initials: D
authors.lastname: Paquette
authors.forename: Micheline
authors.initials: M
authors.lastname: Luneau
authors.forename: Pierre
authors.initials: P
authors.lastname: Julien
authors.forename: Serge
authors.initials: S
authors.lastname: Goulet
authors.forename: Jean
authors.initials: J
authors.lastname: Desaulniers
authors.forename: Paule
authors.initials: P
authors.lastname: Maltais
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011792:Quebec; D012189:Retrospective Studies