The impact of a quality improvement continuing medical education intervention on physicians' vaccination practice: a controlled study.

This study investigated the impact of a longitudinal quality improvement continuing medical education (CME) intervention on influenza and pneumococcal vaccination rates for patient populations at high-risk or aged ≥ 65. An observational cohort design with a propensity score to adjust for vaccine eligibility between the intervention and control cohorts was utilized to assess the impact of the intervention among primary care physicians. The intervention was a three-stage quality improvement initiative with CME learning activities. Stage A was an assessment of practice to establish baseline performance. Stage B was participation in learning interventions and individualized action planning for practice change, and Stage C was practice reassessment. Data were also collected for a control group of clinicians who did not participate during the same period. One hundred primary care physicians completed all 3 intervention stages10/14 - 7/15. Altogether, 361,528 patient records of vaccine receipt were compared for those physicians who completed the educational intervention and those who did not. The percentage of physicians' adult patients receiving influenza or pneumococcal vaccination increased on all measures. The difference between intervention versus control groups was 3.4% higher for influenza ≥ 65 years, 2.1% for influenza high-risk, 0.6% for pneumococcal ≥ 65 years, and 1.4% for pneumococcal high-risk. These results show that physician participation in a quality improvement CME initiative can be an effective strategy to improve vaccination administration. The findings strengthen the evidence that CME learning interventions can advance quality improvement goals and more favorably affect physicians' practice when educational strategies are utilized.

Confidence-based learning CME: overcoming barriers in irritable bowel syndrome with constipation.

INTRODUCTION: Performance of health care professionals depends on both medical knowledge and the certainty with which they possess it. Conventional continuing medical education interventions assess the correctness of learners' responses but do not determine the degree of confidence with which they hold incorrect information. This study describes the use of confidence-based learning (CBL) in an activity designed to enhance learners' knowledge, confidence in their knowledge, and clinical competence with regard to constipation-predominant IBS (IBS-C), a frequently underdiagnosed and misdiagnosed condition. METHODS: The online CBL activity included multiple-choice questions in 2 modules: Burden of Care (BOC; 28 questions) and Patient Scenarios (PS; 9 case-based questions). After formative assessment, targeted feedback was provided, and the learner focused on material with demonstrated knowledge and/or confidence gaps. The process was repeated until 85% of questions were answered correctly and confidently (ie, mastery was attained). RESULTS: Of 275 participants (24% internal medicine, 13% gastroenterology, 32% family medicine, and 31% other), 249 and 167 completed the BOC and PS modules, respectively. Among all participants, 61.8% and 98.2% achieved mastery in the BOC and PS modules, respectively. Baseline mastery levels between specialties were significantly different in the BOC module (p = 0.002); no significant differences were evident between specialties in final mastery levels. Approximately one-third of learners were confident and wrong in topics of epidemiology, defining IBS and constipation, and treatments in the first iteration. No significant difference was observed between specialties for the PS module in either the first or last iterations. DISCUSSION: Learners achieved mastery in topics pertaining to IBS-C regardless of baseline knowledge or specialty. These data indicate that CME activities employing CBL can be used to address knowledge and confidence gaps.

Current and emerging therapies for osteoporosis.

Bone remodeling is a dynamic process in which activated osteoclasts resorb bone and osteoblasts generate a bone matrix that undergoes mineralization. This process repairs microdamage' the microscopic cracks that develop in bone during regular activity-and ensures skeletal strength. A number of local and systemic factors mediate bone cell activity. Systemic regulators include endogenous parathyroid hormone (PTH), vitamin D metabolites, prostaglandins, cortisol, and sex hormones. A number of cytokines and growth factors regulate bone cell function at the local level. For example, bone resorption and formation are tightly orchestrated via the RANK/receptor activator of NF-kappa B ligand (RANKL)/osteoprotegerin (OPG) system. Estrogen deficiency, glucocorticoid use, and immune-mediated conditions lead to an imbalance in the RANKL-OPG ratio, inducing osteoclastogenesis and accelerated bone resorption. A number of steps in the tightly orchestrated bone remodeling process can be targeted with pharmacotherapy. This article reviews the available and emerging treatments that inhibit resorption (the antiresorptive or anticatabolic agents) or augment bone formation (anabolic therapy).