Sandelowsky Hanna, Krakau Ingvar, Modin Sonja, Ställberg Björn, Nager Anna
Division of Family Medicine and Primary Care, NVS, Karolinska Institutet, Alfred Nobels Allé 23, D2, Huddinge, Stockholm, 14183, Sweden.
Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Trials. 2017 Apr 27;18(1):197. doi: 10.1186/s13063-017-1889-4.
Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality worldwide. It is often undiagnosed and insufficiently managed. Effective forms of continuing medical education (CME) for primary care physicians (PCPs) are necessary to ensure the implementation of guidelines in clinical practice and, thus, improve patients' health.
In this study, we will measure the effects of CME by Case Method and compare them against those of traditional lectures and no CME at all through an unblinded, cluster randomised controlled trial (CRCT). Thirty-three primary health care centres (PHCCs) in Stockholm, Sweden, with a total of 180 PCPs will be involved. Twenty-two primary PHCCs, will be cluster-randomised into: an intervention group who will receive CME by Case Method (n = 11) and a control group who will receive traditional lectures (n = 11). The remaining PHCCs (n = 11) will be a reference group and will receive no CME. From the intervention and control groups, 460 randomly selected patients with COPD in GOLD stages 2 and 3 will participate, while no patients will be recruited from the reference group. For the patients, smoking status, actual treatment and urgent visits to a health provider due to airway problems will be registered. For the PCPs, professional competence (i.e. knowledge and management skills) in COPD, will be measured using a questionnaire based on current guidelines and guideline implementation problems in clinical practice which has previously been described by the authors. Data will be collected at baseline and at follow-up, which will be after 1.5 years for the patients, and 1 year for the PCPs. Statistical methods for individual-level and cluster-level analyses will be used.
COPD is considered a particularly complex clinical challenge involving managing multimorbidity, symptom adaptation, and lifestyle problematisation. Case Method in CME for PCPs may contribute to a better understanding of the impact of COPD on patients' lives and, thus, improve their management of it. The present study is expected to contribute scientific knowledge about indicators for an effective CME in COPD that is tailor-made to primary care physicians.
ClinicalTrials.gov, identifier: NCT02213809 . Registered on 10 August 2014. Protocol version: Issue date: May 2014.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的常见原因。它常常未被诊断且管理不足。对基层医疗医生（PCP）进行有效的继续医学教育（CME）形式对于确保临床实践中指南的实施，从而改善患者健康是必要的。
在本研究中，我们将通过案例法测量继续医学教育的效果，并通过非盲、整群随机对照试验（CRCT）将其与传统讲座以及完全不进行继续医学教育的效果进行比较。瑞典斯德哥尔摩的33个初级卫生保健中心（PHCC），共180名基层医疗医生将参与其中。22个初级PHCC将被整群随机分为：接受案例法继续医学教育的干预组（n = 11）和接受传统讲座的对照组（n = 11）。其余的PHCC（n = 11）将作为参照组，不接受继续医学教育。从干预组和对照组中，将随机选取460名GOLD 2期和3期的COPD患者参与，而参照组不招募患者。对于患者，将记录吸烟状况、实际治疗情况以及因气道问题紧急就诊的情况。对于基层医疗医生，将使用基于当前指南以及作者先前描述的临床实践中指南实施问题的问卷来测量其在COPD方面的专业能力（即知识和管理技能）。数据将在基线时以及随访时收集，患者的随访时间为1.5年后，基层医疗医生的随访时间为1年后。将使用个体水平和整群水平分析的统计方法。
COPD被认为是一个特别复杂的临床挑战，涉及管理多种疾病、症状适应以及生活方式问题。针对基层医疗医生的案例法继续医学教育可能有助于更好地理解COPD对患者生活的影响，从而改善他们对其的管理。本研究预计将为针对基层医疗医生的COPD有效继续医学教育指标贡献科学知识。
ClinicalTrials.gov，标识符：NCT02213809。于2014年8月10日注册。方案版本：发布日期：2014年5月。
