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Comparative trial of a short workshop designed to enhance appropriate use of screening tests by family physicians
Marie-Dominique Beaulieu1, Michèle Rivard, Eveline Hudon
1Department of Family Medicine, Université de Montréal, Quebec. maried.beaulieu@sympatico.ca
Background:
Educational interventions that support the implementation of complex clinical practice guidelines (CPGs) require substantial time commitments from participants. We conducted a comparative study to evaluate if a 90-minute workshop would increase compliance with the recommendations of the Canadian Task Force on Preventive Health Care as well as decrease the ordering of tests not the subject of specific recommendations.
Methods:
Eighty-seven family physicians from Quebec participated in the study. Group assignment was initially randomized, but, owing to logistic problems, randomization was not maintained. After unannounced visits, 2 standardized patients coded the physicians' performance of 23 items recommended for inclusion in the periodic health examination (10 for men and 13 for women) and 8 items recommended for exclusion (4 for both men and women). The "exposed" physicians were visited within 4 to 6 months after the workshop. The "nonexposed" physicians were visited within 4 to 6 months after consent was obtained but before they attended the workshop. We used linear regression analysis to determine if exposure to the workshop resulted in improved performance.
Results:
Exposure to the workshop was not associated with a difference in the adjusted mean score for items recommended for inclusion (12.07 for exposed physicians v. 12.35 for those not exposed; maximal and ideal score 23; r = -0.28; 95% confidence interval [CI] = -1.63 to 1.08). However, workshop exposure was associated with lower adjusted mean scores for items recommended for exclusion (1.55 v. 3.17; maximal score 8, ideal score 0; r = -1.63; 95% CI = -2.50 to -0.75) and for other tests (3.59 v. 6.53; r = -2.95; 95% CI = -5.10 to -0.79).
Interpretation:
A short workshop can decrease the ordering of unnecessary screening tests by family physicians. Given its low cost and its potential for general application, such an intervention can support the implementation of prevention CPGs.
