Biomedical subjects

Linda Casebeer

Publications and source records attributed to Linda Casebeer.

16 recordsLinked to original sources

PubMed2006

Evaluation of an online bioterrorism continuing medical education course.

INTRODUCTION: Much of the international community has an increased awareness of potential biologic, chemical, and nuclear threats and the need for physicians to rapidly acquire new knowledge and skills in order to protect the public's health. The present study evaluated the educational effectiveness of an online bioterrorism continuing medical education (CME) activity designed to address clinical issues involving suspected bioterrorism and reporting procedures in the United States. METHODS: This was a retrospective survey of physicians who had completed an online CME activity on bioterrorism compared with a nonparticipant group who had completed at least 1 unrelated online CME course from the same medical school Web site and were matched on similar characteristics. An online survey instrument was developed to assess clinical and systems knowledge and confidence in recognition of illnesses associated with a potential bioterrorism attack. A power calculation indicated that a sample size of 100 (50 in each group) would achieve 90% power to detect a 10% to 15% difference in test scores between the two groups. RESULTS: Compared with nonparticipant physicians, participants correctly diagnosed anthrax (p = .01) and viral exanthem (p = .01), but not smallpox, more frequently than nonparticipants. Participants knew more frequently than nonparticipants who to contact regarding a potential bioterrorism event (p = .03) Participants were more confident than nonparticipants about finding information to guide diagnoses of patients with biologic exposure (p = .01), chemical exposure (p = .02), and radiation exposure (p = .04). DISCUSSION: An online bioterrorism course shows promise as an educational intervention in preparing physicians to better diagnose emerging rare infections, including those that may be associated with a bioterrorist event, in increasing confidence in diagnosing these infections, and in reporting of such infections for practicing physicians.

Attitude of Health Personnel↗

PubMed2005

Improving physician performance through Internet-based interventions: who will participate?

BACKGROUND: The availability of Internet-based continuing medical education is rapidly increasing, but little is known about recruitment of physicians to these interventions. OBJECTIVE: The purpose of this study was to examine predictors of physician participation in an Internet intervention designed to increase screening of young women at risk for chlamydiosis. METHODS: Eligibility was based on administrative claims data, and eligible physicians received recruitment letters via fax and/or courier. Recruited offices had at least one physician who agreed to participate in the study by providing an email address. After one physician from an office was recruited, intensive recruitment of that office ceased. Email messages reminded individual physicians to participate by logging on to the Internet site. RESULTS: Of the eligible offices, 325 (33.2%) were recruited, from which 207 physicians (52.8%) participated. Recruited versus nonrecruited offices had more eligible patients (mean number of eligible patients per office: 44.1 vs 33.6; P < .001), more eligible physicians (mean number of eligible physicians per office: 6.2 vs 4.1; P < .001), and fewer doctors of osteopathy (mean percent of eligible physicians per office who were doctors of osteopathy: 20.5% vs 26.4%; P = .02). Multivariable analysis revealed that the odds of recruiting at least one physician from an office were greater if the office had more eligible patients and more eligible physicians. More participating versus nonparticipating physicians were female (mean percent of female recruited physicians: 39.1% vs 27.0%; P = .01); fewer participating physicians were doctors of osteopathy (mean percent of recruited physicians who were doctors of osteopathy: 15.5% vs 23.9%; P = .04) or international medical graduates (mean percent of recruited physicians who were international graduates: 12.3% vs 23.8%; P = .003). Multivariable analysis revealed that the odds of a physician participating were greater if the physician was older than 55 years (OR = 2.31; 95% CI = 1.09-4.93) and was from an office with a higher Chlamydia screening rate in the upper tertile (OR = 2.26; 95% CI = 1.23-4.16). CONCLUSIONS: Physician participation in an Internet continuing medical education intervention varied significantly by physician and office characteristics.

Adult↗

PubMed2005

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients.

OBJECTIVE: To evaluate patient and physician factors associated with prevention of glucocorticoid-induced osteoporosis and to describe temporal trends in screening and prevention of glucocorticoid-induced osteoporosis. METHODS: Using databases from a national managed care organization, enrollees who had been prescribed glucocorticoids (taken for at least 60 days) during an 18-month period were identified. Administrative data from January 2001 through June 2003 and linked survey data from October 2003 were examined for measurement of bone mass, prescription of antiresorptive medication, and use of over-the-counter calcium and/or vitamin D treatment. Factors associated with screening and bone-protective therapies were identified using multivariable logistic regression, focusing on physician specialty and survey respondent ethnicity. Trends in glucocorticoid-induced osteoporosis prevention were assessed using administrative data from 2001-2003 versus 1995-1998. RESULTS: We identified 6,281 patients who were prescribed glucocorticoids in 2001-2003 (mean +/- SD prescribed prednisone-equivalent dosage 16 +/- 14 mg/day). Forty-two percent underwent bone mass measurement and/or were prescribed bone-protective medication; rates were lowest for men (25%). Compared with patients of internists, the odds of bone mass measurement were lowest among patients prescribed glucocorticoids by family physicians (odds ratio [OR] 0.56 [95% confidence interval] [95% CI] 0.30-1.04) and highest among patients prescribed glucocorticoids by rheumatologists (OR 1.48 [95% CI 1.06-2.08]). Patients prescribed glucocorticoids by gastroenterologists were less likely to be treated with antiresorptive agents (OR 0.49 [95% CI 0.28-0.86]). African American patients were less likely than white patients to be screened (OR 0.55 [95% CI 0.40-0.75]) or treated (OR 0.71 [95% CI 0.51-0.98]). The frequency of bone mass measurement among glucocorticoid-treated patients in 2001-2003 increased 3-fold compared with 1995-1998, and the use of prescription antiresorptive medication increased approximately 2-fold. CONCLUSION: Despite significant temporal increases in the frequency of screening for and treatment of glucocorticoid-induced osteoporosis, absolute rates remain low, especially among men, African Americans, and patients of certain physician specialties.

Adult↗

PubMed2005

Attributes of an ideal continuing medical education institution identified through nominal group technique.

INTRODUCTION: Continuing medical education (CME) is an important resource physicians use to maintain their clinical competence. While many options for CME programs are available, there are few measures of their impact and few measures for physicians to use to systematically gauge their efforts in maintaining competence. This study initiates a process designed to identify key attributes of an ideal CME institution, defined as one that facilitates ways for individual physicians to maintain their competence. METHOD: Using a nominal group technique (NGT), two sessions were conducted with panels of experts in the field. The NGT systematically elicits and prioritizes panelists' responses to a specific question. A larger review panel then rated the importance of each attribute. RESULTS: Panel I: Highest priority attributes: Develops programs based on gaps in healthcare outcomes (8 votes); Has ready access to performance data (6 votes); Has measurement capability that enables tracking individual practice and program performance (6 votes). Panel II: Highest priority attributes: Has adequate resources to accomplish objectives (5 votes); Conducts outcomes assessments (5 votes); Links CME and continuous improvement (5 votes); Employs staff that is able and willing to "think out of the box" (5 votes). The highest rated attributes of the larger panel were: links CME and continuous improvement; develops and promotes programs based on gaps in healthcare outcomes and evidence-based content; and has access to needs data. DISCUSSION: Using an expert panel to define the key attributes of an ideal CME institution creates a roadmap for excellence. An ideal CME institution is one that provides CME that demonstrates effectiveness in supporting physicians' efforts to maintain competence.

Education, Medical, Continuing↗

PubMed2005

Multicomponent Internet continuing medical education to promote chlamydia screening.

BACKGROUND: Low Chlamydia trachomatis screening rates create an opportunity to test innovative continuing medical education (CME) programs. Few studies of Internet-based physician learning have been evaluated with objective data on practice patterns. DESIGN: This randomized controlled trial tested a multicomponent Internet CME (mCME) intervention for increasing chlamydia screening of at-risk women aged 16 to 26 years. SETTING: Eligible physician offices had > or =20 patients at risk for chlamydia as defined by the Health Plan Employer Data and Information Set (HEDIS), had at least one primary care physician (internal medicine, family medicine/general practice, pediatrics) with Internet access, and participated in the study managed care organization. The 191 randomized primary care offices represented 20 states. INTERVENTION: The intervention, available from February to December 2001, consisted of four case-based learning modules, was tailored in real time to each physician based on theory of behavior change, and included office-level feedback of chlamydia screening rates. MAIN OUTCOME MEASURE: HEDIS chlamydia screening rates for the pre-intervention (2000) and post-intervention (2002) periods. RESULTS: Pre-intervention screening rates for the intervention and comparison offices were 18.9% and 16.2% (p =0.135). Post-intervention screening rates for the intervention and comparison offices were 15.5% and 12.4%, respectively (p =0.044, adjusting for baseline performance). CONCLUSIONS: The substantial decline in chlamydia screening rates observed in the comparison offices was significantly attenuated for the intervention offices. The mCME favorably influenced chlamydia screening by primary care physicians.

Adolescent↗

PubMed2005

Chlamydia screening of at-risk young women in managed health care: characteristics of top-performing primary care offices.

OBJECTIVES: Despite effective approaches for managing chlamydial infection, asymptomatic disease remains highly prevalent. We linked administrative data with physician data from the American Medical Association physician survey to identify characteristics of primary care offices associated with best chlamydia screening practices. STUDY: Criteria from the National Committee for Quality Assurance provided chlamydia screening rates. We defined top-performing offices as those with rates in the top decile among 978 primary care offices from 26 states. RESULTS: Offices screened an average of 16.2% of at-risk, young women, but top-performing offices screened 42.2%. Top-performing offices on average had more black physicians (12.5%, 5.1%, P = 0.001) and were more often located in zip code areas with median income less than $30,000 (22.6%, 5.5%, P = 0.001). CONCLUSIONS: Although chlamydia screening rates are alarmingly low overall, there is substantial variation across offices. Understanding predictors of better office performance may lead to effective interventions to promote screening.

Adolescent↗

PubMed2005

Online bioterrorism continuing medical education: development and preliminary testing.

OBJECTIVE: Education to achieve awareness and competency in responding to incidents of bioterrorism is important for health care professionals, especially emergency physicians and nurses, who are likely first points of medical contact. The authors describe the development of a computer-based approach to initial education, incorporating a screensaver to promote awareness and a Web-based approach to provide initial content competency in the areas of smallpox and anthrax. METHODS: Screensavers were developed and tested on emergency department rotating senior medical students and internal medicine interns. Conceptually, screensavers were designed as "billboards" for attracting attention to the educational domain. Five rotating images sequenced at five-second intervals incorporated a teaser question and an interactive toolbar. An interactive toolbar was linked to a Web site that provided content on smallpox and anthrax for hospital-based specialties (emergency physicians and nurses, infection control practitioners, pathologists, and radiologists). The content included both summary and comprehensive content as well as free continuing education credits in an online, specialty-specific, case-scenario format with remediation pop-up boxes. RESULTS: Formal testing indicated that the screensaver and Web site combination deployed on computers in the emergency department and the events of the fall of 2001 significantly increased the percentage of correct responses to five standardized bioterrorism questions. Formal evaluation with a randomized trial and long-term follow-up is ongoing. CONCLUSIONS: Screensavers and Web sites can be used to increase awareness of bioterrorism. Web-based education may provide an effective means of education for bioterrorism.

Awareness↗

PubMed2004

Using email reminders to engage physicians in an Internet-based CME intervention.

BACKGROUND: Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives are to investigate 1) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email announcements, as well as 3) how quickly and when they respond to email announcements. METHODS: Over a 45-week period, 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women's health guideline reinforcing CME activity. Participation was defined as physician log-on at least once to the website. Data were analyzed to determine participation, to compare characteristics of participants with recruited physicians who did not participate, and to determine at what point and when participants logged on. RESULTS: Of 445 recruited physicians with accurate email addresses, 47.2% logged on and completed at least one module. There were no significant differences by age, race, or specialty between participants and non-participants. Female physicians, US medical graduates and MDs had higher participation rates than male physicians, international medical graduates and DOs. Physicians with higher baseline screening rates were significantly more likely to log on to the course. The first 10 emails were the most effective in engaging community-based physicians to complete the intervention. Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday. CONCLUSIONS: Email course reminders may enhance recruitment of physicians to interventions designed to reinforce guideline adoption; physicians' response to email reminders may vary by gender, degree, and country of medical training. Repetition of email communications contributes to physician online participation.

Adult↗

PubMed2004

Standardizing evaluation of on-line continuing medical education: physician knowledge, attitudes, and reflection on practice.

INTRODUCTION: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses. METHODS: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later Paired t tests were used to compare the means of responses across time. RESULTS: U.S. physicians completed 720 post-tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatisfaction. Overall mean knowledge scores increased from 58.1% to 75.6% at post-test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case-based than for text-based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. CONCLUSIONS: Increases in physician knowledge and knowledge retention were demonstrated following participation in on-line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas.

Curriculum↗

PubMed2003

Racial disparities in osteoporosis prevention in a managed care population.

BACKGROUND: Osteoporosis in black women may result in increased disability, longer hospital stays, and higher mortality compared with white women. However, it is unknown whether osteoporosis treatment or bone mineral density (BMD) measurement is different in these women, particularly in those at highest risk. METHODS: To examine differences and determinants of osteoporosis preventive interventions among white and black women in a large regional health maintenance organization, women 50 years of age and older were surveyed (n = 8,909) to determine their receipt of BMD testing and medical therapies for osteoporosis prevention. RESULTS: After adjusting for potential confounders, black women had two- to threefold lower odds of BMD test or osteoporosis prescription treatment. Even among women with a previous fracture, blacks still had a significantly lower likelihood of both BMD testing and prescription therapy. CONCLUSION: Compared with whites, black women reported significantly less BMD testing and prescription and nonprescription osteoporosis therapy. This disparity was not fully explained by other demographic or risk factor differences.

Black or African American↗

PubMed2002

Physician Internet medical information seeking and on-line continuing education use patterns.

INTRODUCTION: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on-line learning behaviors. The purpose of this study was to examine physician medical information-seeking behaviors and their relevance to continuing education (CE) providers who design and develop on-line CE activities. METHODS: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office-based physicians of all specialties. RESULTS: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internet's professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient-physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24-hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question. DISCUSSION: The importance of the Internet to physician professional development is growing rapidly. Access to on-line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care.

Attitude of Health Personnel↗

PubMed2002

Designing tailored Web-based instruction to improve practicing physicians' chlamydial screening rates.

OBJECTIVE: To design an individualized Web-based continuing medical education (CME) program to improve practicing physicians' chlamydial screening rates. DESCRIPTION: Often unrecognized and untreated, chlamydial infections in young women may cause pelvic inflammatory disease, infertility, and ectopic pregnancy and facilitate the acquisition of HIV. The National Committee for Quality Assurance in 2001 reported chlamydia screening rates to be 23.6% for 16-20-year-olds and 18.3% for 21-26-year-olds. In a collaborative project an academic medical center and a large national managed care organization have developed four tailored Web-based modules for primary care physicians with the goal of improving rates of screening for chlamydia. Each module includes: (1) individual office chlamydial screening rates; (2) interactive cases with real-time comparison of answers with those of peers; (3) a toolbox of office support materials, including patient education materials and guideline summaries; and (4) real-time tailoring of the Web pages based on physicians' interactions with module. Readiness to change and barriers impeding change are assessed during interaction with the module and multiple pathways are created in real time for each physician. Physicians' perceptions of the prevalence of chlamydia in their patient populations and the rate of sexual activity among adolescent girls are also assessed. These variables have been correlated in other studies with low rates of chlamydial screening. Inaccurate perceptions of these variables are considered to constitute a precontemplative stage of change. Specific messages are designed to facilitate increased awareness of chlamydia prevalence, level of sexual activity, and the consequences of failure to screen. For physicians who are aware of the nature and scope of the problems related to chlamydia, messages are tailored to assist them in reducing barriers to screening. A randomized trial of a national sample of primary care physicians is being conducted to determine the effectiveness of this intervention in improving physicians' chlamydial screening rates in sexually active women 16-26 years of age. DISCUSSION: While the Internet offers an educational distribution system accessible to practicing physicians, most CME online programs are text-based and infrequently interactive or guideline-based. It is unlikely that these programs have broad impact on physicians' practice patterns. Neither the broad capacities of Web technologies nor the evidence of effective methods for influencing physicians' practice patterns has influenced the design of most CME programs. The innovative course described above provides individual office feedback on performance, compares physicians' responses with those of their peers, gathers responses to determine physicians' readiness to change practices, and provides branching pathways "on-the-fly" individualized to these responses. The module format is easily adapted to other diseases, able to be linked in an automated fashion to administrative data files, and relatively low in cost to support.

Adolescent↗

PubMed2002

Practice pattern variation in the prevention and treatment of osteoporosis.

Prevention and treatment of osteoporosis will be of increasing importance as the mean age of the world population rapidly increases in the coming decades. Nearly half of postmenopausal women not already diagnosed with osteoporosis have significantly low bone mineral density and are at increased risk of fracture, yet this risk is often unrecognized and untreated. Postmenopausal women who have experienced fractures of the hip, vertebra, and wrist and patients using glucocorticoids are at highest risk of fractures but often remain untested and untreated for osteoporosis. Because of the rising societal costs of osteoporosis anticipated in coming years, an improved understanding of the predictors of practice pattern variations and interventions designed to improve underutilization of appropriate care are important to clinicians, health services researchers, and policy makers.

Female↗

PubMedDate not supplied

Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing.

OBJECTIVES: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs. DESIGN: The authors conducted a cross-sectional national survey. PARTICIPANTS: This study consisted of a random national sample of MED DIRs (n = 1300) and DONs (n = 1300) belonging to the American Medical Directors Association or the National Association of Directors of Nursing Administration in Long-term Care. MEASUREMENTS: A 24-item survey using a five-point Likert scale was developed. The survey measured agreement to questions in four domains (provider factors, guideline characteristics, patient factors, environmental factors) and 10 content areas (problem acknowledgment, patient/family concern, patient/family compliance, testing availability, safety, reimbursement, regulatory oversight, staff knowledge/time/ability, belief in guidelines, and malpractice liability). Response distributions to each item were plotted and differences between MED DIRs and DONs were tested. RESULTS: Survey response rates were 40% for MED DIRs and 48% for DONs. Respondents strongly agreed that fractures are a problem in their facilities and that osteoporosis guidelines are useful and cost-beneficial (mean responses > or = 4.0). A large proportion of respondents (at least 40% of the sample) identified multiple patient comorbidities, reimbursement issues, length of stay, and regulatory oversight as barriers to providing osteoporosis care. Respondents did not believe that patient and family acceptance, testing availability, staff time, staff self-efficacy, or concerns about bisphosphonate safety were barriers to osteoporosis care. DONs were more likely than MED DIRs to believe that patients and families are concerned about fractures, whereas MED DIRs were more likely to endorse length of stay, staffing issues, and regulatory oversight as influencing treatment decisions. Years of practice and facility size, but not formal geriatrics training, significantly influenced responses. CONCLUSION: Perceived barriers to implementing osteoporosis guidelines differ between facilities and between MED DIRs and DONs. Identification of these barriers could facilitate quality improvement initiatives and improve the quality of osteoporosis care.

Aged↗

PubMedDate not supplied

Survey of physician knowledge about hemochromatosis.

PURPOSE: To survey physicians about knowledge of hemochromatosis. METHODS: A questionnaire was faxed to American physicians. RESULTS: A total of 2,563 evaluable responses were obtained. There were > or = 70% correct responses about at-risk population, associated abnormalities, and population screening. There were 32% and 53% correct answers about diagnosis and treatment, respectively. A total of 8.0% and 4.9% reported asking > 75% of patients about family history of hemochromatosis and iron overload, respectively. Less than 25% requested HFE mutation analysis in the previous year. Correct answers were associated with academic practice, internal medicine specialty, and medical school graduation within 10 years. CONCLUSION: Many physicians have inadequate knowledge about hemochromatosis diagnosis and treatment.

Clinical Competence↗

PubMedDate not supplied

Barriers to providing osteoporosis care in skilled nursing facilities: perceptions of medical directors and directors of nursing.

OBJECTIVES: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the perceptions of MED DIRs and DONs. DESIGN: The authors conducted a cross-sectional national survey. PARTICIPANTS: This study consisted of a random national sample of MED DIRs (n=1300) and DONs (n=1300) belonging to the American Medical Directors Association or the National Association of Directors of Nursing Administration in Long-term Care. MEASUREMENTS: A 24-item survey using a five-point Likert scale was developed. The survey measured agreement to questions in four domains (provider factors, guideline characteristics, patient factors, environmental factors) and 10 content areas (problem acknowledgment, patient/family concern, patient/family compliance, testing availability, safety, reimbursement, regulatory oversight, staff knowledge/time/ability, belief in guidelines, and malpractice liability). Response distributions to each item were plotted and differences between MED DIRs and DONs were tested. RESULTS: Survey response rates were 40% for MED DIRs and 48% for DONs. Respondents strongly agreed that fractures are a problem in their facilities and that osteoporosis guidelines are useful and cost-beneficial (mean responses > or = 4.0). A large proportion of respondents (at least 40% of the sample) identified multiple patient comorbidities, reimbursement issues, length of stay, and regulatory oversight as barriers to providing osteoporosis care. Respondents did not believe that patient and family acceptance, testing availability, staff time, staff self-efficacy, or concerns about bisphosphonate safety were barriers to osteoporosis care. DONs were more likely than MED DIRs to believe that patients and families are concerned about fractures, whereas MED DIRs were more likely to endorse length of stay, staffing issues, and regulatory oversight as influencing treatment decisions. Years of practice and facility size, but not formal geriatrics training, significantly influenced responses. CONCLUSION: Perceived barriers to implementing osteoporosis guidelines differ between facilities and between MED DIRs and DONs. Identification of these barriers could facilitate quality improvement initiatives and improve the quality of osteoporosis care.

Attitude of Health Personnel↗