Program For Primary Care Physicians Research Articles

Polypharmacy and medication usage patterns in hypertensive patients: Findings from the Pars Cohort Study

Polypharmacy, defined here as the concomitant use of five or more medications, is a significant health issue, particularly affecting individuals with chronic diseases like hypertension (HTN). To compare individuals with and without HTN in term of polypharmacy, and to investigate correlates of polypharmacy and medication use patterns in individuals with HTN in southwest Iran. This cross-sectional study used the baseline data of 9270 participants of the Pars Cohort Study (PCS) with a mean age of 52.6 ± 9.7 years. Poisson multivariable modeling was applied to identify correlates of polypharmacy, and Lexicomp® was used to assess drug-drug interactions. Anatomical Therapeutic Chemical classification was used to describe the pattern of medication use. The prevalence of polypharmacy in individuals without hypertension was 4.7 % (4.2%–5.2 %) vs. 23.7 % (22.1%–25.3 %) in individuals with hypertension (P < 0.001). Individuals with hypertension from middle-high socioeconomic status (SES) had a 1.51-fold higher prevalence of polypharmacy than vs. low SES. Those with more than three comorbidities had a 5.18 times higher prevalence of polypharmacy than those with isolated hypertension. Calcium channel blockers were the most common antihypertensives (20.9 %). In terms of drug-drug interactions, type C interactions were most prevalent among participants with hypertension and polypharmacy (76.0 %). Our findings imply a fairly high prevalence of polypharmacy and drug-drug interactions among individuals with hypertension; to tackle this issue, we recommend a national pharmacovigilance system, training programs for primary care physicians, public education and awareness campaigns, drug-checking campaigns, targeted screenings to alter modifiable risk factors, and the use of safe combination pills.

The use of diagnostic ultrasound by primary care physicians in Switzerland – a cross-sectional study

BackgroundDiagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland.MethodsThis was a cross-sectional study. We invited PCPs from the Swiss practice-based research network “Sentinella” to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months – divided into 4 groups to account for seasonal differences.ResultsOut of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training.The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour).ConclusionMost Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland.Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.

Procedural skills workshops for primary care physicians in Israel: a comprehensive analysis

BackgroundSome of the most common complaints addressed by primary care physicians (PCPs) require manual procedures, such as lacerations repair, abscesses drainage, ingrown toenails removal, dry needling for myofascial pain syndrome, and Epley maneuver for treating benign paroxysmal positional vertigo (BPPV). The aim of this study was to describe the procedural skills workshops program for PCPs implemented in Maccabi Healthcare Services and to investigate how many PCPs have participated and used the skills since the program’s inception in 2017.MethodsIn this observational study, we followed all participants in courses from 2017 to 2021. We extracted all procedures performed during these years by PCPs who learned the skill in MHS.ResultsDuring the study period, 620 PCPs participated in workshops for dry needling, soft-tissue and joint injections, BPPV treatment, minor surgical procedures, and spirometry. Most procedures performed were dry needling (average annual number 3,537) and minor surgical procedures (average annual number 361). The average annual use per physician was highest for dry needling (annual average use per physician who used the learned skill was 50.9), followed by soft tissue and joint injections (16.8), minor surgical procedures (14.8), and BPPV treatment (7.5).Conclusionprocedural skills workshops may expand PCPs’ therapeutic arsenal, thus empowering PCPs and providing more comprehensive care for patients. Some manual skills, such as dry needling, soft tissue injections, and the Epley maneuver, were more likely to be used by participants than other skills, such as spirometry and soft tissue injections.

Training program for primary care physicians in medical rehabilitation at the Pacifi c Medical University

This article describes the experience of training primary care physicians in the field of medical rehabilitation. The existing procedure for the arrangement of medical rehabilitation prescribes its rules and order of implementation in medical primary health care organizations both in outpatient and day patient settings. The Pacific State Medical University (PSMU) runs training programs for primary care physicians within the 31.05.01 educational program “General Medicine”, direction “02 Healthcare”. In accordance with the curriculum, a training program “Medical Rehabilitation” that includes both lectures and training sessions was developed. This program is aimed at forming the necessary competencies of future primary care physicians in implementing and monitoring the effectiveness of the patient’s medical rehabilitation. Training is carried out at the facilities of the PSMU Institute of Clinical Neurology and Rehabilitation Medicine by specialists having experience in medical rehabilitation and having completed the program “Modern aspects of specialist training in the field of physical and rehabilitation medicine”.

Continuing medical education programs for primary care physicians from remote locations of Vietnam: a needs assessment

BackgroundInadequate attention has been given to ensuring ongoing training to improve knowledge, skills and capacity of primary health care providers in low- and middle-income countries. The Hanoi Medical University, Vietnam is providing training sessions for physicians working in commune health stations (CHSs) in three mountainous, remote northern provinces in 2019. This article aims to assess these physicians’ knowledge of correct medical responses to emergencies in order to assess their training needs.MethodsWe conducted a cross-sectional study amongst doctors posted to CHSs located in 3 mountainous remote provinces of northern Vietnam. We used a self-administered questionnaire that comprised questions on common medical emergencies, maternal and child care, and non-communicable disease management. We performed Chi-square tests to assess the statistical significance of differences in the mean proportions of correct answers for each health care question category, and for differences in mean proportions of correct answers by doctor characteristics.ResultsIn total 302 doctors were recruited to the study. More than half of the sample answered 30–50% of the questions correctly, followed by around a third who answered 50–70% correctly. Less than 2% of doctors answered more than 70% correct responses to the entire question set. There were statistically significant differences between question categories, with cardiovascular care questions answered correctly significantly less often than any of the categories (p < 0.00001).ConclusionThe findings reported here show that the doctors who participated in the study have relatively low knowledge on common emergencies, particularly to answer cardiovascular care questions. The results also support the need for continuing medical education to improve doctors’ knowledge, who are mostly practicing in resource limited remote settings.

Opportunities and Limitations in Global Mental Health Training: A Qualitative Study of Jordanian Primary Care Physicians

ABSTRACT Cultural stigma combined with limited available qualified mental health professionals in the setting of political conflict and a refugee crisis represent great challenges toward providing mental health care to patients in the country of Jordan. We conducted focus groups with eight physicians to evaluate the Global Mental Health Certificate Program (GMHC) a novel program for primary care physicians intended at improving mental health diagnosis and treatment utilizing psychotherapy and pharmacotherapy. With the use of educational modules focused on mental health with major component on family therapy the program had positive impacts on information and attitude of mental health over and above other continuing education opportunities. However, it was also shown that stigma, time limitations, resources, and gaps in continuing education limit the application of these benefits. We provide recommendations for those teaching and designing mental health programs based on focus group recommendations and current literature.

Long-term effectiveness of a primary care practice facilitation program for chronic kidney disease management: an extended follow-up of a cluster-randomized FROM-J study.

Practice facilitation program by multidisciplinary care for primary care physicians (PCPs) is expected to improve chronic kidney disease (CKD) outcomes, but there is no clear evidence of its long-term effectiveness. We have previously performed a cluster-randomized controlled trial for 3.5 years (the Frontier of Renal Outcome Modifications in Japan (FROM-J) study) with two arms-group A without the program and group B with the program. We aimed to assess the long-term effectiveness of the practice facilitation program on CKD outcomes via an extended 10-year follow-up of the FROM-J study. We enrolled patients who were in the FROM-J study. The primary composite endpoint comprised cardiovascular disease (CVD), renal replacement therapy initiation and a 50% decrease in the estimated glomerular filtration rate (eGFR). The secondary endpoints were survival rate, eGFR decline rate and collaboration rate between PCPs and nephrologists. The occurrence of the primary composite endpoint tended to be lower in group B (group A: 27.1%versus group B: 22.1%, P=0.051). Furthermore, CVD incidence was remarkably lower in group B (group A: 10.5%versus group B: 6.4%, P=0.001). Although both mortality and the rate of eGFR decline were identical between both groups, the eGFR decline rate was significantly better in group B than in group A only in patients with stage G3a at enrollment (group A: 2.35±3.87mL/min/1.73m2/year versus group B: 1.68±2.98mL/min/1.73m2/year, P=0.02). The collaboration rate was higher in group B. The CKD practice facilitation program for PCPs reliably decreases CVD events and may reduce the progression of cases to end-stage kidney disease.

Emergence of diabetes education and capacity-building programs for primary care physicians in India

Diabetes is one of the leading causes of death globally. India is home to the second-largest population suffering from diabetes. This underscores the need to build capacity of primary care physicians (PCPs) for better disease management. This narrative review article aims to describe the emergence of diabetes education and capacity-building programs for PCPs and its current situation in India. The review highlighted that major emphasis on diabetes was given only when the WHO estimated that morbidity and mortality due to diabetes would increase to 35% in India. As a result, National Diabetes Control Program was launched in 1987. Yet, very little attention was paid to diabetology in under-graduation. In the last decade, few public and private institutions have developed diabetes related capacity-building programs for PCPs independently or in collaborations. These programs include 16 fellowships, 4 diplomas, 12 certificate programs, and 6 other diabetes training programs, which have their own pros and cons. As medical science is changing rapidly, PCPs need to upgrade their skills and knowledge regularly to manage NCDs such as diabetes more effectively and efficiently. This can be possible only if scientific, evidence-based, and quality-oriented capacity-building programs are provided to the healthcare workforce.

Certificate Course in Occupational Safety and Health: A Capacity Building Program for Primary Care Physicians based on Adult Learning Model.

Context:The need for physicians qualified in the field of occupational safety and health (OSH) is growing with the growth of manufacturing and service sectors where maximum number of work-related morbidity and mortality occur.Aims:This article aims to assess the effectiveness and feasibility of the certificate course in occupational safety and health for training and capacity building of primary care physicians in OSH.Methods and Material:Guideline for reporting evidence-based practice educational interventions and teaching (GREET) was used for describing educational interventions. The outcome was assessed by comparing the mean scores. t test with P < 0.005 was considered a level of significance.Results:The result showed significant improvement in the cumulative pre- and post-test scores after each module. The certificate course is suitable for adult learning as there was no intergroup difference in knowledge after the program. Consistent with the findings, the improvement scores indicate that training has made a difference in the knowledge and learning of the trained physicians.Conclusions:This customized training intervention has high potential for scaling up while optimally addressing the scarcity of trained physicians in the OSH in high population density settings like India where a high number of vulnerable workforces work in the informal economy.

Post‐COVID‐19: Designing the new normal in general medicine

The impact of COVID-19 in the last 6 months (as of June 23, 2020) has been over 900 deaths and over 17 700 confirmed cases in Japan.1 The negative effects of COVID-19 to the economy, medical education, and the medical system are countless. However, they allowed us to reconsider a “new normal” for general physicians and gave us a new turning point.2 We discussed that the fundamental change in the post-COVID-19 era will be that physical and spatial limitations would be erased by technology. Based on the discussion, we suggest changes to three domains in the medical sector (Table 1). First, this pandemic played a selective role in distinguishing between work that can be replaced with online processes and work for which on-site presence is vital.3 Given that general medicine involves the three aspects of clinical practice, education, and research, we believe that education and research are two fields that can rapidly move online. Online medical education will transcend the boundaries between universities and hospitals; outstanding educational opportunities would become open to everyone, and exceptional educators can be selected. Research for general physicians will cover a wide range of healthcare fields, including clinical research that can be performed in primary care settings, family medicine, public health, medical education, quality and safety, medical informatics, etc.4 However, this move from the real to virtual world can create disparity between those who can access and use the Internet effectively and those who cannot. Nevertheless, some work would have to inevitably move online post-COVID-19. Second, the gap in learning opportunities close to residences will be resolved; the self-learning ability online will aid improvement in the ability of doctors.4 Learning contents will be freely available through universities and well-known training hospitals. This will reduce the disparity in postgraduate education levels, which was difficult to access in remote areas. Fusion with technology will promote new general medicine; diagnosis through artificial intelligence, virtual reality training for physical examination, and telemedicine are a few examples.3 Third, general physicians may change their self-criteria when choosing a workplace, thanks to freedom from physical restraints. As a doctor, one can decide where and with whom to live and what kind of work to do. Accordingly, with this change in physical and time restrictions, the criteria for evaluating work for rewards and income should also change. This would involve a radical change in the work for general physicians. For instance, it is highly likely that a general physician will be able to perform additional jobs online. Thus, we propose the “new normal” in general medicine based on general theory from existing literature. In Japan, a new training program for primary care physicians was launched in 2018. In other words, we were already gearing up for a “new normal” in healthcare provision. Therefore, rather than lamenting the inevitable changes, we should be professionals who can respond flexibly to the changes in the near future. Face-to-face meetings including outpatient clinics and home visits are the norm. Education, meetings, and conferences are mostly conducted in person. Classes and lectures are provided in real time by the instructor. Clinical clerkships are mainly conducted in real clinical settings. Research is limited to universities and some hospitals, and conducting research has been difficult in remote areas for solo practitioners Online treatment and prescriptions are applied in clinical practice. Advances in diagnostic aid technologies The online system promotes development of training and research across institutions. Clinical clerkship or training is provided on the go, with the addition of simulations, virtual reality, and online education. Online networks will make it easier to participate in research for solo practitioners working in remote areas Learners mostly resort to a local society or training hospital to acquire their knowledge or skills. Basically, workshops and conferences are limited to those who directly participate in them. Role models and mentors of primary care physicians are often only close to the learner. Attendance at conferences requires physical mobility Learning online, including on-demand content and live streaming. Sharing of education from a distance: liberating sophisticated conferences on the web for all learners. Role models are now easier to access from a distance. Attendance at conferences is possible online as well Workplace defines where the physician lives. Supplying primary care to remote areas requires physicians to stay there. Wages and compensation are paid in units of hours and days Possibility of resolving time and space constraints enables diversity of working style. The importance of considering where you live decreases The evaluation parameters for physician's work may change The authors thank Professor Kazumichi Onigata, Dean of faculty of medicine, Shimane University, for his careful supervision. None.

How a problem-based learning approach could help Japanese primary care physicians: a qualitative study.

ObjectivesThis study aimed to identify training needs among primary care physicians in Japan who had no formal primary care training. Methods We conducted a focus group interview with seven Japanese primary care physicians who had not previously undergone specialist training in primary care and had been recruited to a family medicine training program that used a problem-based learning approach. At the start of the program, the physicians attended the interview. The discussion was recorded, and the transcribed interview was analyzed using the Steps for Coding and Theorization method. Results Three main themes emerged. First, there is a lack of standard re-education programs for physicians who move away from their specializations into primary care. Second, there is insufficient training on primary care in undergraduate and postgraduate medical education in Japan. Third, continuing professional development programs should cover the communication skills, attitudes, and behaviors necessary for primary care practice. Conclusions This study clarified the needs to be addressed in our training program for primary care physicians involved in retraining in primary care. It is important to consider how to best include the communication skills, attitudes, and behaviors necessary for primary care among the topics covered in the program. As the program undergoes further iteration, it will be important to check whether it meets the needs of primary care practitioners. It will be necessary to investigate the needs of re-education programs for more physicians in many areas, and to emphasize the importance of primary care re-education in these abilities in undergraduate and postgraduate medical education.

672-P: Diabetes Education Model for Primary Care Physicians (PCPs)

India is home to over 72.9 million individuals with diabetes which is expected to rise to 134.3 million by 2045. Given the low doctor population ratio, maldistribution of specialists with an urban preference and initial diagnosis being made by non-specialists, strengthening primary health care is the key in effectively addressing this challenge. Considering the burden, Public Health Foundation of India in 2010 launched pan-India capacity building programs for PCPs. The aim of these programs is to enhance knowledge, skills and core competencies of PCPs in managing diabetes and comorbidities. The program is conceptualized and built on a PPP model with the involvement of various stakeholders including implementing, academic, funding partners, national experts (33), faculty (428), observers (150) and PCPs. Every stakeholder has unique role and responsibilities (Figure). A total 16878 PCPs have been trained under these programs in 101 cities across 27 states/UTs. Passing percentages ranged from 88 to 92 with an average score of 39 out of 50. PCPs reported a significant increase in knowledge (p&amp;lt;0.05) and confidence in managing diabetes in end line evaluation and establishing a referral linkage in an organic manner. The learning from the model is now adopted by other LMICs including Bangladesh, Nepal, Myanmar, Afghanistan and East African countries that are in throes of an alarming burden of diabetes and shortage of trained physicians. Disclosure S. Bhalla: None. P. Kumar: None. R. Mehra: None.

A12710 Collaborating with state governments for building capacity of medical officers in the management of hypertension and its complications

Objectives: To improve the knowledge and skills of government medical officers in the management of hypertension and related complications using a multiple stakeholder model for capacity building. Methods: Public Health Foundation of India, International Society of Hypertension, British Hypertension Society and Centre for Chronic Disease Control jointly developed and delivered a countrywide program for primary care physicians. The course was later adopted by three state governments in India (Madhya Pradesh, Meghalaya and Tripura) under the National Health Mission for training of their respective medical officers. The curriculum was developed by international societies and contextualized by a panel of national experts. This was later delivered by faculty nominated by the state. The course had a strong built-in monitoring and evaluation component that assured standardized delivery and quality of the program. Results: A total of 213 participants were trained in the state of Madhya Pradesh and were posted at their respective health centres as NCD nodal officers post-training. Over 90% of the medical officers trained felt that the course improved their knowledge and confidence in the management of hypertension. In the state of Meghalaya, 20 medical officers are currently undergoing training. The state government of Tripura will nominate 40 medical officers to be trained in the course. Conclusion: Building capacity of primary care physicians could help reduce the burden on the government tertiary care system and also help strengthen state primary health systems. The model presented can be easily adopted by other state governments as well as low and middle income countries that have similar health system settings.

Primary care doctor fostering and clinical research training in Sweden: Implications for Japan.

In 2018, a new training program for primary care physicians was launched in Japan. As physicians responsible for the training of new primary care physicians, we have faced many problems, particularly in rural areas. The influence of this new program on primary care physicians in rural areas of Japan has not been sufficiently investigated. The aim of this research was to improve training for primary care physicians in Japan by examining training programs in Sweden, where the population challenges are similar to those seen in Japan. In this paper, we will express our opinions and describe the differences in the primary care fostering systems and clinical research training for generalist in Japan and Sweden.

PS218 Education Programs for Primary Care Physicians: An Experience From Various Capacity Building Initiatives on Chronic Conditions in India

PS218 Education Programs for Primary Care Physicians: An Experience From Various Capacity Building Initiatives on Chronic Conditions in India

A migraine management training program for primary care providers: An overview of a survey and pilot study findings, lessons learned, and considerations for further research.

There are five to nine million primary care office visits a year for migraine in the United States. However, migraine care is often suboptimal in the primary care setting. A prior study indicated that primary care physicians (PCPs) wanted direct contact with headache specialists to improve the migraine care they provide. We sought to further examine PCPs' knowledge of migraine management and assess the feasibility of a multimodal migraine education program for PCPs. We conducted a survey assessing PCPs' knowledge about migraine. We then held three live educational sessions and developed an email consultative service for PCPs to submit questions they had about migraine. We report both quantitative and qualitative findings. Twenty-one PCPs completed the survey. They were generally familiar with the epidemiology of migraine (mean prevalence of migraine reported was 12.6% ± 10.1), the psychiatric comorbidities (mean prevalence of comorbid depression was 24.5% ± 16.7, mean prevalence of comorbid anxiety was 24.6% ± 18.3), and evidence-based behavioral treatments. Fifty-six percent cited cognitive behavioral therapy, 78% cited biofeedback, and 61% cited relaxation therapy as evidence based treatments. Though most were aware of the prevalence of psychiatric comorbidities, they did not routinely assess for them (43% did not routinely assess for anxiety, 29% did not routinely assess for depression). PCPs reported frequently referring patients for non-level A evidence based treatments: special diets (60%), acupuncture (50%), physical therapy (30%), and psychoanalysis (20%). Relaxation therapy was a therapy recommended by 40% of the PCPs. Only 10% reported referring for cognitive behavioral therapy or biofeedback. Nineteen percent made minimal or no use of migraine preventive medications. Seventy-two percent were unaware of or only slightly aware of the American Academy of Neurology guidelines for migraine. There was variable attendance at the educational sessions (N=22 at 1st session, 6 at 2nd session, 15 at 3rd session). Very few PCPs used the email consultative service (N=4). Though PCPs are familiar with many aspects of migraine care, there is a need and opportunity for improvement. The three live sessions were poorly attended and the email consultative service was rarely used. We provide an in depth discussion of targeted areas for educational intervention, of the challenges in developing a migraine educational program for PCPs, and areas for future study.

Effects of Educational Interventions for Chronic Airway Disease on Primary Care.

Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.

Clinical Care Pathways for Patients With Hepatitis C: Reducing Critical Barriers to Effective Treatment.

Background. Engagement of individuals infected with hepatitis C virus (HCV) with care pathways remains a major barrier to realizing the benefits of new and more effective antiviral therapies. After an exploratory study, we have undertaken an evidence-based redesign of care pathways for HCV, including the following: (1) reflex testing of anti-HCV-positive samples for HCV RNA; (2) annotation of laboratory results to recommend referral of actively infected patients to specialist clinics; (3) educational programs for primary care physicians and nurses; and (4) the establishment of needs-driven community clinics in substance misuse services. Methods. In this study, we conducted a retrospective cohort study of progression through care pathways of individuals with a new diagnosis of HCV infection made between January 2010 and January 2012. We also analyzed patient flow through new care pathways and compared this with our baseline study of identical design. Results. A total of 28 980 samples were tested for anti-HCV antibody during the study period and yielded 273 unique patients with a new diagnosis of HCV infection. Of these, 38% were tested in general practice, 21% were tested in substance misuse services, 23% were tested in secondary care, and 18% were tested in local prisons. Overall, 80% of patients were referred to specialist clinics, 70% attended for assessment, and 38% commenced treatment, in comparison to 49%, 27%, and 10%, respectively, in the baseline study. Referral rates from all testing sources improved. Conclusions. This study provides timely evidence that progression through care pathways can be enhanced, and it demonstrates reduction of key barriers to eradication of HCV.

Applying the ADDIE—Analysis, Design, Development, Implementation and Evaluation—Instructional Design Model to Continuing Professional Development for Primary Care Physicians in Saudi Arabia

Background: As professionals, family physicians are obliged to remain current on advances and trends in medicine and health care delivery. This is usually achieved through engagement in continuing professional development. Instructional design is a systematic method of development of education and training programs for improved learner performance. ADDIE is an instructional systems design model for building effective education and training in five phases: analysis, design, development, implementation and evaluation. Purpose: The purpose of this study was to introduce a professional development program for primary care physicians using the ADDIE instructional design model. Methods: Program requirements were defined using a needs assessment questionnaire and consultation observations. Interactive sessions were designed and developed based on the analysis results. The sessions were evaluated with interim and final feedback forms, a final problem-based questionnaire, a self-assessment questionnaire, and focus groups. Results: Scores on the final knowledge assessment were lower than expected. However, at least 50% of participants self-reported their learning improvement as “great” for 16 out of 23 topics. Focus group feedback was generally positive but also identified areas for improvement. Conclusion: Applying a structured instructional design model for creating professional development program for physicians is a fruitful, relevant experience in primary healthcare. 1) Continuing professional development (CPD) is an essential method to help physicians maintain and further develop knowledge and expertise; 2) The ADDIE (analysis, design, development, implementation, evaluation) model provides an established and useful structure for creating effective CPD programs; 3) The ADDIE process ensures that physicians’ appropriate learning needs are met effectively; 4) The evaluation phase of the ADDIE process provides feedback that can lead to improvement in the CPD program’s future iterations.

Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?

IntroductionChildhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates.MethodsThe study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1–Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.ResultsThe PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021).ConclusionsThe P4P program had a limited impact on vaccination rates and did not address health inequity.