Potomac Center for Medical Education, Columbia, MD 21046, USA.
Int J Chron Obstruct Pulmon Dis. 2011;6:297-307. doi: 10.2147/COPD.S18257. Epub 2011 May 23.
Major clinical gaps impede the evidence-based treatment of chronic obstructive pulmonary disease (COPD) in the primary care setting. Studies are needed to measure the effectiveness of continuing medical education (CME) on improving physician competency and performance toward evidence-based COPD care.
Between September 26, 2009 and December 12, 2009, 769 primary care physicians participated in a series of 12 regional, live, interactive, case-based, multiformat, half-day CME programs on COPD. A subgroup of randomly selected participants (n = 50) and demographically matched nonparticipants (n = 50) completed surveys that included case vignettes, a validated tool for measuring physician performance in clinical practice. Cohen's d was used to calculate the magnitude of difference between participants and nonparticipants in the delivery of evidence-based care.
Physicians who participated in CME programs were 50% more likely to provide evidence-based COPD care than physicians who did not participate. Compared with nonparticipants, participating physicians were more likely to recognize COPD correctly in a patient presenting with dyspnea (74% versus 94%, P = 0.007), recognize that women may have a greater susceptibility than men to the toxic effects of smoking (54% versus 90%, P < 0.001), and identify the mechanisms of action of emerging therapies (33% versus 65%, P = 0.003).
Physicians who participated in a half-day regional CME program on COPD diagnosis, staging, and treatment were significantly more likely than nonparticipants to deliver evidence-based COPD care. With multiformat, interactive, focused educational interventions, physicians can make diagnostic and therapeutic choices in the primary care setting that align more closely with current guidelines and clinical evidence in COPD management.
主要的临床差距阻碍了慢性阻塞性肺疾病（COPD）在初级保健环境中的循证治疗。需要研究来衡量继续医学教育（CME）对提高医生在循证 COPD 护理方面的能力和表现的有效性。
在 2009 年 9 月 26 日至 2009 年 12 月 12 日期间，769 名初级保健医生参加了一系列 12 个区域、现场、互动、基于案例、多格式、半天的 COPD 继续教育课程。随机选择的参与者亚组（n=50）和人口统计学匹配的非参与者（n=50）完成了调查，其中包括案例病例，这是一种用于衡量医生在临床实践中表现的有效工具。使用 Cohen's d 计算参与者和非参与者在提供循证护理方面的差异程度。
参加 CME 计划的医生提供循证 COPD 护理的可能性比未参加的医生高 50%。与非参与者相比，参加 CME 计划的医生更有可能正确识别出现呼吸困难的患者的 COPD（74%比 94%，P=0.007），认识到女性可能比男性更容易受到吸烟的毒性影响（54%比 90%，P<0.001），并确定新兴疗法的作用机制（33%比 65%，P=0.003）。
参加 COPD 诊断、分期和治疗半天区域 CME 计划的医生比非参与者更有可能提供循证 COPD 护理。通过多格式、互动、重点教育干预，医生可以在初级保健环境中做出更符合 COPD 管理中当前指南和临床证据的诊断和治疗选择。
