USING ECONSULTS TO INFORM CARDIOLOGY CONTINUING MEDICAL EDUCATION NEEDS OF PRIMARY CARE PROVIDERS

Abstract

Cardiology knowledge transfer for primary care providers (PCPs) has traditionally been delivered through continuing medical education (CME) events. Ideally, CME for PCPs should align with clinical questions and fill knowledge gaps required for patient care. Established in 2010, the Champlain BASE (Building Access to Specialist Advice) eConsultation service permits PCPs to submit patient-specific clinical questions to specialists via secure web service. To gain insight into PCP cardiology CME needs, we compared eConsult cardiology questions with topics offered at the largest provincial cardiology PCP CME events. 120 cardiology eConsult questions were categorized for type of question ie. diagnosis/treatment using a validated taxonomy, and the specific cardiology content modified from the International Classification for Primary Care (ICPC-2) by consensus of the investigators (CJ,NG,EK). The same taxonomy was used to classify cardiology content at the last 5 years of the Heart and Stroke Foundation of Ontario Annual Clinical Update, a CME course attended by 600 PCP’s per year. The content of the cardiology eConsult questions were compared with PCP cardiology CME topics. Cardiology-content specific categorization of 120 eConsults revealed questions related to arrhythmia (17%), drug/disease interactions (15%), CAD (13%), ECG (12%), AFib (11%), Echo (7%), thoracic aneurysm (5%), HTN (5%), lipids (4%), long QT syndrome (4%), other (7%). Cardiology-content specific categorization of 11480 minutes of cardiology topics at the Annual Clinical Update revealed content related to HTN (24%), CAD (20%), AFib (18%), CHF (11%), heart valve/murmur (6%), lipids (5%), risk Factors (4%), ECG (3%), other (9%). Review of the drug/disease interactions questions reveals that PCPs are asking about interactions between non-cardiac drugs (eg. psychiatric drugs) and a cardiac condition. Drug/disease interactions, thoracic aneurysm, and long QT syndrome account for 24% of eConsult questions, but are not covered at the Heart and Stroke Foundation of Ontario Annual Clinical Update. PCPs are asking about specific content areas that are not covered in the largest PCP cardiology CME event in our province. In particular, interaction between non-cardiac conditions / treatments and cardiac disease is an important area not being addressed. By evaluating questions generated from every-day patient problems faced by PCPs, our analysis can serve as a needs assessment to guide cardiology CME for PCPs. The value of eConsult content in directing specialist knowledge transfer to primary care physicians warrants further study.