title: The impact of a heart failure educational program for physicians varies based upon physician specialty.
abstract: BACKGROUND
  Beta blocker (BB) doses are often suboptimal in heart failure (HF) management. Differences in BB management patterns may exist between physicians in family medicine (FM) and internal medicine (IM). The aims of this study were to compare: 1) BB doses and prescription patterns; and 2) health care utilization rates in patients cared for by all primary care physicians compared to an historical control group after an educational program on HF management. A subgroup analysis was performed between patients cared for by FM and IM physicians. A secondary aim was to assess physician knowledge scores and satisfaction.
  
  
  METHODS
  A historically controlled study was conducted among low-income, underserved HF patients (mean age 54.1 ± 13.1, males 70%, mean ejection fraction 28.2 ± 9.8%). Statistical methods included linear mixed models and Fisher's exact tests to assess prescription patterns of BB dosing and health care utilization rates (all cause and HF related hospitalizations, emergency department use and clinic visits).
  
  
  RESULTS
  Among 135 patients (experimental N = 81 and control N = 54), a linear mixed model test of group by time interaction showed no difference in BB dosage (t = -0.12, P = 0.91). FM physicians prescribed significant changes in BB doses compared to IM physicians (P = 0.04), had higher numbers of clinic visits (P = 0.03) and reported greater satisfaction with the program.
  
  
  CONCLUSIONS
  There was no difference in BB titration rates following an HF training intervention for physicians compared to historical controls. However, FM physicians had a greater change in prescribing practices compared to IM physicians. Educational programs targeting FM physicians may benefit HF patients and could potentially lead to greater adherence to clinical guidelines related to BB use and address gaps in providing HF care.
authors.affiliation: San Francisco VA Medical Center, 4150 Clement Street 181G, San Francisco, CA 94121, USA.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Park
authors.affiliation: Contra Costa Regional Medical Center, 2500 Alhambra Ave, Martinez, CA 94553, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Mahar
authors.affiliation: California Pacific Medical Center, 2200 Webster St, San Francisco, CA 94115, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: Department of Physiological Nursing, University of California, 2 Koret Way, N611, San Francisco, CA 94143, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
keywords: Beta blocker; Education; Family medicine; Heart failure; Internal medicine; Practice variation; Primary care physician
references.citation: Am Heart J. 2006 May;151(5):992-8
references.pmid: 16644320
references.citation: PLoS One. 2009 Dec 31;4(12):e8522
references.pmid: 20046824
references.citation: JAMA. 2011 Oct 19;306(15):1669-78
references.pmid: 22009099
references.citation: Congest Heart Fail. 2012 Jan-Feb;18(1):9-17
references.pmid: 22277172
references.citation: Health Aff (Millwood). 2007 Sep-Oct;26(5):1459-68
references.pmid: 17848458
references.citation: J Am Coll Cardiol. 1997 Sep;30(3):733-8
references.pmid: 9283533
references.citation: Eur J Heart Fail. 2005 Aug;7(5):921-6
references.pmid: 16051519
references.citation: Rev Cardiovasc Med. 2003;4 Suppl 7:S21-30
references.pmid: 14668697
references.citation: Ann Intern Med. 2000 Feb 1;132(3):191-200
references.pmid: 10651599
references.citation: Arch Intern Med. 2001 Oct 8;161(18):2223-8
references.pmid: 11575979
references.citation: Chest. 1999 Aug;116(2):346-54
references.pmid: 10453861
references.citation: Am Heart J. 1997 Jun;133(6):703-12
references.pmid: 9200399
references.citation: Am Heart J. 2000 Mar;139(3):491-6
references.pmid: 10689264
references.citation: Circulation. 2009 Apr 14;119(14):e391-479
references.pmid: 19324966
references.citation: Circulation. 2003 Jun 10;107(22):2799-804
references.pmid: 12756157