Improving primary care in British Columbia, Canada: evaluation of a peer-to-peer continuing education program for...

An innovative program, the Practice Support Program (PSP), for full-service family physicians and their medical office assistants in primary care practices was recently introduced in British Columbia, Canada. The PSP was jointly approved by both government and physician groups, and is a dynamic, interactive, educational and supportive program that offers peer-to-peer training to physicians and their office staff. Topic areas range from clinical tools/skills to office management relevant to General Practitioner (GP) practices and "doable in real GP time". PSP learning modules consist of three half-day learning sessions interspersed with 6-8 week action periods. At the end of the third learning session, all participants were asked to complete a pen-and-paper survey that asked them to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients.

A total of 887 GPs (response rates ranging from 26.0% to 60.2% across three years) and 405 MOAs (response rates from 21.3% to 49.8%) provided responses on a pen-and-paper survey administered at the last learning session of the learning module. The survey asked respondents to rate (a) their satisfaction with the learning module components, including the content and (b) the perceived impact the learning has had on their practices and patients. The psychometric properties (Chronbach's alphas) of the satisfaction and impact scales ranged from .82 to .94.

Evaluation findings from the first three years of the PSP indicated consistently high satisfaction ratings and perceived impact on GP practices and patients, regardless of physician characteristics (gender, age group) or work-related variables (e.g., time worked in family practice). The Advanced Access Learning Module, which offers tools to improve office efficiencies, decreased wait times for urgent, regular and third next available appointments by an average of 1.2, 3.3, and by 3.4 days across all physicians. For the Chronic Disease Management module, over 87% of all GP respondents developed a CDM patient registry and reported being able to take better care of their patients. After attending the Adult Mental Health module: 94.1% of GPs agreed that they felt more comfortable helping patients who required mental health care; over 82% agreed that their skills and their confidence in diagnosing and treating mental health conditions had improved; and 41.0% agreed that their frequency of prescribing medications, if appropriate, had decreased. Additionally for the Adult Mental Health module, a 3-6 month follow-up survey of the GPs indicated that the implemented changes were sustained over time.

GP and medical office assistant participant ratings show that the PSP learning modules were consistently successful in providing GPs and their staff with new learning that was relevant and could be implemented and used in "real-GP-time".