Paul Christine L, Piterman Leon, Shaw Jonathan E, Kirby Catherine, Forshaw Kristy L, Robinson Jennifer, Thepwongsa Isaraporn, Sanson-Fisher Robert W
Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.
University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
Trials. 2017 Mar 23;18(1):137. doi: 10.1186/s13063-017-1869-8.
In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.
Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.
Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.
There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.
Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976 . Retrospectively registered on 31 May 2011.
在澳大利亚，农村和偏远社区的糖尿病相关死亡率及住院率很高。全科医生在糖尿病检测和管理中发挥着主要作用。对全科医生进行教育能够优化糖尿病管理，并在人群层面改善患者预后。本研究旨在描述针对农村全科医生的继续医学教育干预措施的接受情况，及其对一项关于继续医学教育对全镇糖尿病监测与控制效果的整群随机对照试验可行性的影响。
试验设计：整群随机对照试验以城镇作为分配和分析单位，通过去识别化的病理数据评估结果（此处未报告）。干预方案包括一个在线主动学习模块、直接电子获取专家建议及绩效反馈。采用多轮邀请以使全科医生参与在线干预内容。基于证据的策略（如预先通知、奖励、激励措施）被纳入参与该项目的邀请中。在研究干预期间，通过托管软件包对项目招募情况进行电子监测。
该研究纳入了11对匹配的城镇。11个干预城镇中有146名全科医生，其中34名（23.3%）参与了该项目，8名（5.5%）完成了在线学习模块。没有一个城镇有超过10%的常驻全科医生完成学习模块。全科医生未就专家建议请求进行任何联系。因此，该试验停止。
持续需要让基层医疗医生参与改善农村地区的糖尿病监测和管理。在线培训选项虽然在理论上有吸引力且易于获取，但即使实施了基于证据的招募策略，其接受程度也不太可能很高。
澳大利亚新西兰临床试验注册中心，标识符：ACTRN12611000553976。于2011年5月31日追溯注册。
