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. 1994 Dec;161(6):572–578.

Physician management of hypercholesterolemia. A randomized trial of continuing medical education.

W S Browner 1, R B Baron 1, S Solkowitz 1, L J Adler 1, D S Gullion 1
PMCID: PMC1022738  PMID: 7856157

Abstract

To determine the effect of continuing medical education (CME) on compliance with the recommendations of the National Cholesterol Education Program Expert Panel on high serum cholesterol levels in adults, we randomly assigned primary physicians in 174 practices to 3 groups, 2 that underwent either standard or intensive CME and a control group. The standard CME group was offered a free 3-hour seminar on high serum cholesterol levels; the intensive CME group was offered in addition follow-up seminars and free office materials. After 18 months, we audited 13,099 medical records from the 140 practices that remained in the study. There were no significant differences (P > .15) in screening for high serum cholesterol or compliance with guidelines between the groups receiving continuing medical education (51% screening; 33% compliance) and the control group (57% screening; 37% compliance). In the prespecified subgroup of patients with hypercholesterolemia, there was a trend toward a modest benefit from the continuing medical education interventions: compliance was 21% in the control group, 23% in the standard CME group, and 27% in the intensive CME group (P = .07 overall). These results emphasize the need for better ways to change behavior in practicing physicians and the importance of studying the implementation of preventive health recommendations.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Belcher D. W. Implementing preventive services. Success and failure in an outpatient trial. Arch Intern Med. 1990 Dec;150(12):2533–2541. doi: 10.1001/archinte.150.12.2533. [DOI] [PubMed] [Google Scholar]
  2. Block L., Banspach S. W., Gans K., Harris C., Lasater T. M., Lefebvre R. C., Carleton R. A. Impact of public education and continuing medical education on physician attitudes and behavior concerning cholesterol. Am J Prev Med. 1988 Sep-Oct;4(5):255–260. [PubMed] [Google Scholar]
  3. Browner W. S. Estimating the impact of risk factor modification programs. Am J Epidemiol. 1986 Jan;123(1):143–153. doi: 10.1093/oxfordjournals.aje.a114208. [DOI] [PubMed] [Google Scholar]
  4. Cummings S. R., Coates T. J., Richard R. J., Hansen B., Zahnd E. G., VanderMartin R., Duncan C., Gerbert B., Martin A., Stein M. J. Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program. Ann Intern Med. 1989 Apr 15;110(8):640–647. doi: 10.7326/0003-4819-110-8-640. [DOI] [PubMed] [Google Scholar]
  5. Cummings S. R., Richard R. J., Duncan C. L., Hansen B., Vander Martin R., Gerbert B., Coates T. J. Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med. 1989 Nov-Dec;4(6):482–489. doi: 10.1007/BF02599545. [DOI] [PubMed] [Google Scholar]
  6. Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992 Sep 2;268(9):1111–1117. [PubMed] [Google Scholar]
  7. Donner A., Donald A. The statistical analysis of multiple binary measurements. J Clin Epidemiol. 1988;41(9):899–905. doi: 10.1016/0895-4356(88)90107-2. [DOI] [PubMed] [Google Scholar]
  8. Headrick L. A., Speroff T., Pelecanos H. I., Cebul R. D. Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial. Arch Intern Med. 1992 Dec;152(12):2490–2496. [PubMed] [Google Scholar]
  9. Hulley S. B., Newman T. B., Grady D., Garber A. M., Baron R. B., Browner W. S. Should we be measuring blood cholesterol levels in young adults? JAMA. 1993 Mar 17;269(11):1416–1419. [PubMed] [Google Scholar]
  10. Jack B. W., Gans K. M., McQuade W., Culpepper L., Lasswell A., Hume A. L., Dowling P. T., Carleton R. A. A successful physician training program in cholesterol screening and management. Prev Med. 1991 May;20(3):364–377. doi: 10.1016/0091-7435(91)90035-3. [DOI] [PubMed] [Google Scholar]
  11. Jennett P. A., Laxdal O. E., Hayton R. C., Klaassen D. J., Swanson R. W., Wilson T. W., Spooner H. J., Mainprize G. W., Wickett R. E. The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ. 1988 Mar;22(2):139–145. doi: 10.1111/j.1365-2923.1988.tb00424.x. [DOI] [PubMed] [Google Scholar]
  12. Kottke T. E., Brekke M. L., Solberg L. I., Hughes J. R. A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I. JAMA. 1989 Apr 14;261(14):2101–2106. [PubMed] [Google Scholar]
  13. Landzberg J. S., Heim C. R. Physician recognition and treatment of hypercholesterolemia. Arch Intern Med. 1989 Apr;149(4):933–935. [PubMed] [Google Scholar]
  14. Lurie N., Slater J., McGovern P., Ekstrum J., Quam L., Margolis K. Preventive care for women. Does the sex of the physician matter? N Engl J Med. 1993 Aug 12;329(7):478–482. doi: 10.1056/NEJM199308123290707. [DOI] [PubMed] [Google Scholar]
  15. Maiman L. A., Becker M. H., Liptak G. S., Nazarian L. F., Rounds K. A. Improving pediatricians' compliance-enhancing practices. A randomized trial. Am J Dis Child. 1988 Jul;142(7):773–779. doi: 10.1001/archpedi.1988.02150070087033. [DOI] [PubMed] [Google Scholar]
  16. Manning P. R., DeBakey L. Lifelong learning tailored to individual clinical practice. JAMA. 1992 Sep 2;268(9):1135–1136. [PubMed] [Google Scholar]
  17. Schucker B., Wittes J. T., Santanello N. C., Weber S. J., McGoldrick D., Donato K., Levy A., Rifkind B. M. Change in cholesterol awareness and action. Results from national physician and public surveys. Arch Intern Med. 1991 Apr;151(4):666–673. [PubMed] [Google Scholar]
  18. Sox H. C., Jr Screening for lipid disorders under health system reform. N Engl J Med. 1993 Apr 29;328(17):1269–1271. doi: 10.1056/NEJM199304293281711. [DOI] [PubMed] [Google Scholar]
  19. Wentz D. K., Osteen A. M., Cannon M. I. Continuing medical education. Unabated debate. JAMA. 1992 Sep 2;268(9):1118–1120. [PubMed] [Google Scholar]
  20. White P. T., Pharoah C. A., Anderson H. R., Freeling P. Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract. 1989 May;39(322):182–186. [PMC free article] [PubMed] [Google Scholar]
  21. Whiteside C., Robbins J. A. Cholesterol knowledge and practices among patients compared with physician management in a university primary care setting. Prev Med. 1989 Jul;18(4):526–531. doi: 10.1016/0091-7435(89)90011-x. [DOI] [PubMed] [Google Scholar]

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