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PEDIATRICS Vol. 101 No. 5 May 1998, pp. 831-836

Impact of Education for Physicians on Patient Outcomes

Received Jul 18, 1997; accepted Nov 18, 1997.

Noreen M. Clark*, Molly Gong, M. Anthony SchorkDagger , David Evansparallel , Dietrich Roloff§, Martin Hurwitz§, Lois Maiman#, and Robert B. Mellins

From the Departments of * Public Health and Dagger  Biostatistics, School of Public Health, and the § Department of Pediatrics and Communicable Disease, School of Medicine, University of Michigan, Ann Arbor, Michigan; the Departments of parallel  Clinical Public Health and  Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York; and the # National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Objectives.  This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1) the treatment practices and communications and education behavior of physicians, 2) the health status and medical care utilization of their pediatric patients with asthma, and 3) the satisfaction with care of the subjects' parents.

Methods.  A total of 74 general practice pediatricians were assigned to either a program or a control group in a randomized controlled study. Data were collected from physicians at baseline, and 69 (93%) provided follow-up data 5 months after the program. Data were also collected from 637 of their patients at baseline, and in a 22-month window after the intervention, 472 (74%) of this number provided follow-up data.

Results.  After the seminar, physicians in the program group were more likely than were control group physicians to address patients' fears about medicines, review written instructions, provide a sequence of educational messages, write down how to adjust the medicines at home when symptoms change, and report that they spent less time with their patients. Parents of the children treated by program physicians were significantly more likely than were control group parents to report that the physician had been reassuring, described as a goal that the child be fully active, and gave information to relieve specific worries. After a visit with the physician, these parents were also more likely to report that they knew how to make management decisions at home. After the intervention compared to controls, patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler. After the intervention, children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms; however, there were no differences in emergency department visits and hospitalizations. Among children who were placed on inhaled corticosteroids during this study, however, children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits, and hospitalizations.

Conclusions.  The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.

Key words: patient outcomes, continuing education, asthma, quality of care, patient satisfaction.




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