title: Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters.
abstract: BACKGROUND
  Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs.
  
  
  METHODS
  We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model.
  
  
  CONCLUSIONS
  The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02210442 .
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain. isabel.cura@salud.madrid.org.|Área Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain. isabel.cura@salud.madrid.org.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. isabel.cura@salud.madrid.org.
authors.forename: Isabel
authors.initials: I
authors.lastname: Del Cura-González
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Departamento Medicina, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|C.S. Pintores. Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Pintor Rosales, S/N, 28982, Parla, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: López-Rodríguez
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Sanz-Cuesta
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Grupo Infecciosas Sociedad Madrileña de Medicina Familiar y Comunitaria, (SoMaMFyC), Madrid, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rodríguez-Barrientos
authors.affiliation: Área Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|C.S. Villamanta, Dirección Asistencial Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín-Fernández
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad Docente Multiprofesional Atención Familiar y Comunitaria Oeste, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ariza-Cardiel
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Unidad Docente Multiprofesional Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Polentinos-Castro
authors.affiliation: Unidad Docente Multiprofesional Atención Familiar y Comunitaria Oeste, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Román-Crespo
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Escortell-Mayor
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
authors.forename: Milagros
authors.initials: M
authors.lastname: Rico-Blázquez
authors.affiliation: Grupo Infecciosas Sociedad Madrileña de Medicina Familiar y Comunitaria, (SoMaMFyC), Madrid, Spain.|Mackenzie Building. Kirsty Semple Way, Ninewells Hospital & Medical School, Dundee, DD2 4PF, UK.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernández-Santiago
authors.affiliation: Grupo Infecciosas Sociedad Madrileña de Medicina Familiar y Comunitaria, (SoMaMFyC), Madrid, Spain.|C.S. Pintores. Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Pintor Rosales, S/N, 28982, Parla, Madrid, Spain.
authors.forename: Amaya
authors.initials: A
authors.lastname: Azcoaga-Lorenzo
authors.affiliation: Servicio Medicina Preventiva, Hospital Universitario Severo Ochoa, Avenida de Orellana, s/n, 28911, Leganés, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ojeda-Ruiz
authors.affiliation: Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres, 6, 28035, Madrid, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Grupo Medicina Basada en la Evidencia de la Sociedad Española de Medicina Familiar y Comunitaria, (SoMaMFyC), Madrid, Spain.
authors.forename: Ana I
authors.initials: AI
authors.lastname: González-González
authors.affiliation: C.S. Santa Isabel. Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Paseo de Colón, 3, 28911, Leganés, Madrid, Spain.|Grupo Nuevas Tecnologías Sociedad Madrileña de Medicina Familiar Y Comunitaria, (SOMAMFYC), Madrid, Spain.
authors.forename: José F
authors.initials: JF
authors.lastname: Ávila-Tomas
authors.affiliation: C.S. Jazmín, Unidad Docente Multiprofesional Centro, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Barrio-Cortés
authors.affiliation: Grupo Infecciosas Sociedad Madrileña de Medicina Familiar y Comunitaria, (SoMaMFyC), Madrid, Spain.|C.S. San Andrés, Calle Alberto Palacios 22, 28021, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Molero-García
authors.affiliation: C.S. Entrevias. Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, C/Pedroches c/v Campiña, 28053, Madrid, Spain.|Departamento de fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Raul
authors.initials: R
authors.lastname: Ferrer-Peña
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|C.S. El Naranjo, Calle de Avilés, 2, 28942, Fuenlabrada, Madrid, Spain.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Tello-Bernabé
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Servicio de Evaluación y Planificación, Dirección del Servicio Canario de la Salud, Fundación Canaria de Investigación Sanitaria (FUNCANIS), Camino Candelaria, 44. C.S. San Isidro-El Chorrillo, 38109, El Rosario, Tenerife, España.
authors.forename: Mar
authors.initials: M
authors.lastname: Trujillo-Martín
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D003154:Community Medicine / Q000193:education*; D005194:Family Practice / Q000193:education*; D005500:Follow-Up Studies; D005717:Games, Experimental; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Experimental; Games; Health personnel/education; Practice guidelines as a topic; Problem solving; Professional competence