Hamideh M Esmaily (Karolinska Institutet); Ivan Silver (Toronto University); Niaz Moosavian Fathi (Tabriz University of Medical Sciences); Alireza Gargani (Tabriz University of Medical Sciences); Nasrin Maleki-Dizaji (Tabriz University of Medical Sciences); Rolf Wahlstrom (Karolinska Institutet)
Synopsis
The introduction of an outcome-based approach in CME seems promising when creating programs to improve GPs’ prescribing behavior.
Purpose
Conventional continuing medical education (CME) programs are often unsuccessful in improving medical professionals’ performance. An outcome-based education (OBE) has been proposed to develop more effective CME programs. OBE can influence: decisions about the content, formulation of aims, educational strategies, teaching methods, assessment, and the educational environment. We have used this approach in developing an OBE intervention for general physicians working in primary care (GPs) and evaluated its effectiveness in the field of rational prescribing.
Methods
A cluster randomized controlled design was used. All 159 GPs working in 6 cities, in 2 regions in East Azerbaijan province in Iran, were invited to participate. The cities were matched and randomly divided into an intervention arm, for an OBE program, and a control arm for a traditional CME program on rational prescribing. GPs prescribing behavior was assessed through collecting 10% of their prescriptions, nine months before, and three months after the CME programs.
Results
In total, 112 GPs participated. The GPs in the intervention arm significantly reduced the number of prescribed drugs and the number of injections per prescription. They also increased their compliance with specific requirements for a correct prescription, such as explanation of specific time and manner of intake and precautions necessary when using drugs, with intervention effects of 13, 36, and 42 percentage units, respectively. Compared with the control arm, there was no significant improvement when prescribing antibiotics and anti-inflammatory agents.
Conclusions
Outcome-based program was more effective than concurrent traditional education to develop GPs performance, although several indicators were still suboptimal.
