title: Complex cases in primary care: report of a CME-certified series addressing patients with multiple comorbidities.
abstract: OBJECTIVE
  To assess whether participation in a series of continuing medical education-certified activities presenting complicated case scenarios resulted in evidence-based decision making for patients with chronic comorbid conditions.
  
  
  METHODS
  A series of interactive live workshops and online case studies presented evidence-based, practical information addressing the care of patients with multiple chronic diseases to primary care physicians. Clinical case vignettes were used to assess workshop participant knowledge and competence. Results were compared with those of matched non-participant controls. Online participants were surveyed to evaluate immediate knowledge gains from the activity.
  
  
  RESULTS
  Overall, physician workshop participants were 27% more knowledgeable of evidence-based treatment decisions. Participants were more likely to refer a patient with rheumatoid arthritis to a rheumatologist (57% vs. 36%; p = 0.035) and showed better recognition of medications that can contribute to overactive bladder symptoms (36% vs. 18%; p = 0.043) compared with non-participant controls. Non-significant differences in favour of participants included evidence-based decisions regarding the management of osteoporosis, attention deficit hyperactivity disorder in adults and type 2 diabetes mellitus in adolescents. Online participants demonstrated significant knowledge gains (p < 0.001) on 17 of 18 assessment questions across all therapeutic areas.
  
  
  CONCLUSIONS
  Chronic comorbid conditions afflict a sizable minority of patients. However, specific recommendations and education surrounding patient management are often overlooked because of the inherent difficulty of treating this group. Highly interactive educational activities can improve participant knowledge and competency in treating these patients by providing an opportunity to interact with faculty experts, receive immediate feedback and practice new skills.
  
  
  CONCLUSIONS
  Interactive educational activities that discuss complicated case scenarios can improve participant application of evidence-based medicine for patients with multiple chronic comorbidities.
authors: Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA.
authors: K
authors: K
authors: Andolsek
authors: M T
authors: MT
authors: Rosenberg
authors: M
authors: M
authors: Abdolrasulnia
authors: S A
authors: SA
authors: Stowell
authors: A J
authors: AJ
authors: Gardner
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards; D015897:Comorbidity; D004502:Education, Medical, Continuing / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D009657:North Carolina; D058007:Physicians, Primary Care / Q000193:education*; D010818:Practice Patterns, Physicians' / Q000592:standards