Impact of continuing medical education for primary healthcare providers in Malaysia on diabetes knowledge, attitudes, skills and clinical practices

Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study

There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.

The impact of osteoporosis virtual training course for general practitioners

This study evaluated the impact of a virtual training program on osteoporosis management for general practitioners. Among 498 participants, knowledge scores significantly increased from 38 to 83 (P < 0.001). The findings highlight the effectiveness of targeted education in enhancing practitioners' understanding, ultimately improving patient care and reducing healthcare costs.

PURPOSE

Osteoporosis is a widespread global health concern. Training the general practitioners with updated treatment strategies can notably lessen patient discomfort (fracture and mobility limitation) and costs. So, this study aimed to assess the impact of a training course on osteoporosis management knowledge targeted at general practitioners.

METHODS

A quasi-experimental study was conducted to train general practitioners about Osteoporosis. The study utilized a virtual education program accessible online and contained five key aspects of osteoporosis management. The impact of this program was evaluated by comparing pre-test and post-test scores across all 5 modules. Evaluation of Electronic Modules questionnaire was used to assess the quality of the osteoporosis virtual course. A linear regression analysis explored factors influencing physicians' knowledge percent change in 5 modules.

RESULTS

A total of 498 general practitioners participated in a virtual course on osteoporosis management. The average participant age was 35, and over 70% were women. The mean score for all five modules increased significantly, from 38 to 83, more than double the original score (P < 0.001). The analysis revealed that in Module 3 (Clinical Management), younger participants attained significantly higher post-test scores (β, - 0.28; 95% CI, - 0.55, - 0.01; P, 0.039). Also, most participants agreed or strongly agreed that the system is high-quality, offers valuable information, and services, and is both user-friendly and beneficial.

CONCLUSION

The virtual training course on osteoporosis management principles notably improved the participants' knowledge.

Effectiveness of online education on thermography-based diabetic foot ulcer prevention for wound care specialists: a single-group quasi-experimental study

Background

While there is an urgent need worldwide to establish methods that prevent diabetic foot ulcers, the effectiveness of a prevention protocol using thermography has been reported. As the number of diabetic patients in Indonesia is increasing, an online program for wound care specialists was developed to disseminate this protocol. The present study evaluated the impact of an online program on wound care specialists' knowledge of diabetic foot ulcer prevention using thermography.

Methods

This single-group quasi-experimental study was conducted in cooperation with the Indonesian Wound Enterostomal Continence Nurses Association with regard to curriculum and content design, and the evaluation methods of online education for thermography-based diabetic foot ulcer prevention using the learning management system. A questionnaire with 50 multiple-choice questions previously validated for content and readability on the knowledge of diabetic foot ulcer prevention using thermography was used for training evaluations.

Results

Of 106 Indonesian wound care specialists evaluated, the paired t-test revealed a significant difference between the before and after training questionnaire scores on knowledge (52.0 ± 10.3, 85.2 ± 10.6, respectively, p < 0.001). Repeated measures analysis of variance revealed interactions between time (before and after training) and gender, and between time and type of certificate (p = 0.046, p = 0.014, respectively).

Conclusions

An asynchronous e-learning program is an effective method to increase wound care specialists' knowledge of diabetic foot ulcer prevention. These findings suggest that online educational interventions are effective and can be tailored to meet the needs of healthcare professionals, thereby ultimately contributing to better patient care outcomes in preventing DFUs.

Discrete choice experiment on the preferences for continuing medical education training programs among primary health care physicians in China

BACKGROUND

Improving primary health care (PHC) physician's capacity has been identified as an important area in the healthcare reform. The continuing medical education (CME) training programs are conducive to enhancing competence of PHC physicians. But few studies have explored PHC physicians' needs and preferences for CME training programs. This study aimed to explore the preferences for CME training programs from the perspective of PHC physicians, and to understand the willingness, tendency, and needs in CME.

METHODS

A Discrete Choice Experiment (DCE) was developed based on literature review and semi-structured interviews with 4 general practitioners to identify key attributes of CME programs. The DCE survey was administered to 360 PHC physicians in Jiangsu Province, China, in August 2023, to elicit preferences for: training frequency, training time, training duration, training location, training content of basic medical services, and training content of basic public health services. A total of 281 valid responses were included after the quality control test, which involved checking completion time and consistency in repeated choice tasks. DCE data were analyzed using Mixed Logit, and Latent Class Models to explore preference heterogeneity and class membership.

RESULTS

PHC physicians showed strong preference for CME training programs that were conducted during working hours on weekdays, once a year, at a local meeting place and training on health management of patients with multiple chronic diseases. Latent class analysis identified 2 preference classes, with half (51.2%) of the respondents focused only on training frequency and time while the rest considered training logistic arrangement as well as training content. These preferences could be explained by some observed characteristics of PHC physicians such as age and professional level.

CONCLUSIONS

Overall, PHC physicians valued the convenience of participation in CME training programs and training on health management of patients with multiple chronic disease. Our findings can be used to inform the design of CME training programs for PHC physicians in China.

Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis

BACKGROUND

Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes.

METHODS

A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE.

RESULTS

Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes.

CONCLUSIONS

Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes.

TRIAL REGISTRATION

PROSPERO CRD42019130446.

Physician practices in referring rheumatoid hand and thumb carpometacarpal arthritis cases to hand surgeons

OBJECTIVES

To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low.

METHODS

This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties.

RESULTS

For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management.

CONCLUSION

Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.

Saudi Arabian Physical Therapists' Knowledge, Attitudes, and Clinical Practice in Diabetes Prevention and Management

Objective

This study explores physical therapists' current knowledge, attitudes, and practice toward the management and prevention of diabetes in Saudi Arabia.

Patients and Methods

A cross-sectional survey was distributed among physical therapists in Saudi Arabia. The questionnaire included several sections concerning their knowledge, attitude, and current practice toward diabetic management. A total of 301 physical therapists (32% female) participated in our study.

Results

The results suggest that only half of the participants agreed that diabetes management and prevention were within physical therapy's scope of service. However, approximately 30% of the participants did not regularly check or ask about the glucose levels of their patients with diabetes. Only 55% of the participants correctly answered the knowledge test questions.

Conclusion

This study found that physical therapists in Saudi Arabia have a modest level of diabetes knowledge. The findings indicate that physical therapy educational programs should address diabetes management. Furthermore, continued education is required for current practicing physical therapists in Saudi Arabia.

Cardiovascular Disease-Related Health Promotion and Prevention Services by Pharmacists in Saudi Arabia: How Well Are They Prepared?

BACKGROUND

Cardiovascular diseases (CVDs) have been identified as the leading reason for morbidity and mortality in Saudi Arabia. Pharmacists play a major role in CVD prevention and health promotion. We aimed to assess the knowledge, attitudes, and involvement of pharmacists in CVD prevention and evaluate the influence of continuing medical education in CVD-prevention services in Saudi Arabia.

METHOD

A cross-sectional study was conducted to evaluate the involvement of pharmacists in CVD-related prevention services along with their knowledge and attitudes. A 34-item questionnaire was developed and distributed among the participants.

RESULTS

A total of 324 responses were included in the study. More than 60% of pharmacists had provided counseling regarding the importance of healthy lifestyles and self-monitoring CVD risk factors. About half of the participants (49.1%) had never received any CVD-related continuing medical education. Overall, more than 60% of the participants reported positively towards their role in CVD prevention. Lack of time (66%) and lack of educational materials and tools (41%) were the top perceived barriers for providing CVD-prevention and health-promotion activities, followed by lack of skills in using tools (36%) and lack of privacy/space (33%).

CONCLUSIONS

The involvement of pharmacists in the prevention of CVD is limited in this study. Further education and capacity building are required to strengthen pharmacists' involvement in CVD-prevention and health-promotion activities.

Evaluation of the star family doctors training program: an observational cohort study of a novel continuing medical education program for general practitioners within a compact medical consortium: a quantitative analysis

INTRODUCTION

To determine the effectiveness of the Star Family Doctors Training Program, a comprehensive Continuing professional development (CPD) program for general practitioners (GPs) in a compact medical consortium.

PATIENTS AND METHODS

Observational cohort study with a quantitative analyses in primary health care institutions in Sichuan Province. The interventions were as following: (1) The Star Family Doctors Training Program is a full-time, local government allocation program certified by the Health Department of Sichuan Province, emphasizing small group learning and practice, and using standard patients and medical patient simulators; 30 participants were selected by their institutions. (2) The control group underwent a self-financed after-work CPD program using conventional lectures; 50 participants were self-selected. Short-term effectiveness assessed using immediate post-training tests and self-evaluations; long-term (1 year) effectiveness evaluated using self-reported surveys.

RESULTS

The study involved 80 GPs (28.75% men; mean age: 38.2 ± 9.2 years). The average post-training total score was higher in the STAR group than in the control group (72.83 ± 5.73 vs. 68.18 ± 7.64; p = 0.005). Compared to the controls, STAR participants reported seeing more patients (all p < 0.05), and had more patients who signed family-doctor contracts (p = 0.001) as well as increased patient satisfaction (p = 0.03), respectively. STAR-group trainees appraised the program higher and were more willing to recommend it to colleagues (90% vs. 64%, p = 0.011).

CONCLUSION

The Star Family Doctors Training Program achieved good responses and provides a reference for future CPD programs.

The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals

BACKGROUND

The treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited.

OBJECTIVE

This study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps.

METHODS

Two faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5).

RESULTS

Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22% (11/50) to 60% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32% (11/34) to 59% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.

CONCLUSIONS

Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.

Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers

BACKGROUND AND AIMS

Prevention and management of diabetic foot ulcer have essential effects on the quality of life of patients. Accordingly training the care providers can play an essential role in reducing complications foot ulcers and lead to an increase in the effectiveness and efficiency of patient health cares. We conducted a study to survey the impact of the diabetic foot workshop on the knowledge of nurses and physicians about diagnosis and managing diabetic foot.

METHODS

The present study is a quasi-experimental which compare the knowledge of non-randomized group of nurses and physicians about diabetic foot care. The leaning objectives, agenda, contents and evaluation methods of the diabetic foot care workshop was designed by a multidisciplinary team members in form of 2 days workshop. Each topic of the workshop presented theoretically and practically using educational cases and real patient with diabetic foot ulcer. A valid and reliable questionnaire with 20 Multiple Choice Questions used for the evaluation of workshopin form of the pretest and posttest.

RESULTS

In this study, 396 registered nurses and physicians participates in the diabetic foot workshop series. The results of this study showed that this increase in the level of knowledge was meaningful after the educational intervention since the mean of the posttest score increased more than 20% comparing with pretest.

CONCLUSION

The promotion of knowledge of health care providers as shown in the study may almost be due to training by real patient, team-working, and using educational movies for the education of diabetic foot diagnosis, management and rehabilitation.

Evaluation of clinical efficacy of continuous care with improved insulin injection techniques on patients with diabetes mellitus: a randomized controlled trial

Objective

To investigate the clinical effect of continuous care with improved insulin injection techniques on patients with diabetes mellitus.

Methods

This randomized controlled trial enrolled patients with diabetes mellitus. They were randomly assigned to a control or observation group. Patients in the control group received conventional continuous nursing. Patients in the observation group were given optimized insulin injection education and continuous nursing on the same basis as the conventional nursing used in the control group. Blood glucose-related outcomes, knowledge of insulin injections and adverse events were recorded.

Results

A total of 96 patients with diabetes mellitus were enrolled in the study (n = 48 per group). There were no significant differences between the two groups in terms of sex, age and glycosylated haemoglobin (HbA_1c). Compared with the control group, continuous care combined with optimized insulin injection techniques significantly reduced blood glucose target time, fasting blood glucose, 2-h postprandial blood glucose and HbA_1c. The proportions of patients reporting a subcutaneous mass, insulin leakage and hypoglycaemic events were significantly lower in the observation group; and pain scores were significantly reduced compared with the control group.

Conclusions

Continuous care and optimization of insulin injection techniques can help patients achieve better diabetes-related outcomes.

Study Registration Number: ChiCTR2200057166.

The role of primary physician training in improving regional standardized management of diabetes: a pre-post intervention study

BACKGROUND

Hierarchical diagnosis and treatment has been gradually implemented throughout the China. Primary physicians are the main force in primary-level medical and health services, which means that standardized training of primary-level doctors is indispensable.

OBJECTIVES

Evaluation of the effect of primary physician training on standardized management of diabetes, and comparison of the effects of different training models.

METHOD

The study selected 24 community health service centers from 4 cities in Liaoning Province, and consisted of two groups: primary physicians (n = 2083) who received training; and patients with diabetes (n = 585) in community health service centers. Short-term training effects on primary physicians were assessed through diabetes knowledge tests at baseline and at the end of training; the long-term effects of training on patients with diabetes were assessed by questionnaires at baseline and 1 year after training. The differences in training effects between different training models were compared. Complication screening results were also assessed.

RESULTS

After training, the primary physicians' knowledge of diabetes diagnosis and treatment improved (p < 0.05). The complication screening rate of local diabetes patients increased from 22.2% before training to 27.7% 1 year after training (p = 0.033). There were significant differences in the training effect between different training models (p = 0.038). The short-term intensive training group demonstrated the greatest training effect, primary physicians under this training model are more likely to conduct standardized screenings for patients (OR = 1.806, 95%CI 1.008-3.233), and the complication screening rate was the highest (37.6%).

CONCLUSION

This study shows that training of primary physicians is an effective way to improve the standardized management of diabetes, by improving the ability of primary physicians to manage diabetes in a standardized manner, so that patients in primary hospitals receive more comprehensive diagnosis and treatment services. Compared with scattered training throughout the year, short-term intensive training was found to be more effective.

Research hotspots and trends in nursing education from 2014 to 2020: A co-word analysis based on keywords

AIMS

To investigate research hotspots and trends in nursing education from 2014 to 2020, and provide references for researchers to understand the research status and developing trends in this field.

DESIGN

A co-word analysis based on keywords.

METHODS

Data were obtained from nursing education-related academic research articles that were retrieved through a literature search using PubMed during the period of 2014-2020. Keywords included in the analysis of literature were considered as the research objects. Bibliographic Item Co-occurrence Matrix Builder (BICOMB) was employed to extract high-frequency keywords and generate co-occurrence matrix, graphical clustering toolkit (gCLUTO) was used to perform cluster analysis, and SPSS 25.0 was used to perform strategic diagram analysis.

RESULTS

Overall, 7857 articles were retrieved, from which 2679 keywords were obtained and 64 high-frequency keywords extracted. The results revealed seven hotspots in nursing education during the period of 2014-2020, which included research on: (i) continuing education in nursing, (ii) application and influence of the internet in nursing education, (iii) postgraduate nursing education, (iv) undergraduate nursing education and clinical quality training, (v) current development status and tendency of nursing education, (vi) nursing teaching methods and (vii) organization and management in nursing education.

CONCLUSION

The seven research hotspots could reflect the publication trends in nursing education. By providing a co-word analysis-including cluster and strategic diagram analysis-an overall command of the latest hotspots can be depicted, and researchers conducting research in nursing education can have some hints.

IMPACT

This study allows the development of future research on nursing education. Future researchers should explore the application of new network technologies in the process of nursing teaching, quality of postgraduate nursing education, innovative teaching methods as well as teaching strategies of improving students' clinical ability, current situation of economics and leadership in nursing education and ability of organization and management in undergraduate nursing education.

Impact of Continuing Medical Education for Physicians on the Quality of Cancer Pain Treatment in China

CONTEXT

The management of cancer pain has gained attention in China since the proposal of the three-step analgesic ladder in 1986 and has been further improved after the Chinese Ministry of Health launched the campaign for "Good Pain Management Ward" in 2011. The Beijing Pain Management Center for Quality Control and Improvement was formed with the intent to improve the quality of pain management by various means such as providing continuing medical education (CME) and conducting evaluation in Beijing, the capital of China.

OBJECTIVES

The objective of this study was to investigate the impact of CME on cancer pain treatment in hospitals in Beijing, China.

METHODS

The Beijing Pain Management Center for Quality Control and Improvement carried out annual CME on cancer pain treatment for physicians in Beijing in February from 2016 to 2019. The quality of cancer pain treatment in these hospitals was evaluated in August 2015, 2017 and 2019 by using an evaluation instrument containing eight domains. The evaluation results were retrospectively reviewed to assess the impact of CME.

RESULTS

After annual CME for four successive years, a significant increase in evaluation scores for cancer pain treatment was observed in the participating hospitals. The increased trend varied widely both among the levels of hospitals (secondary and two tiers of tertiary hospitals) and among evaluation domains. These hospitals scored lowest in domains related to opioid tolerance, ongoing care, and risk of nonsteroidal anti-inflammatory drugs in the last evaluation.

CONCLUSION

CME significantly improved the quality of cancer pain treatment in the participating hospitals. Thus, standard CME courses may be adopted to improve the quality of cancer pain treatment by other regions in China and other countries.

Impact of Diabetes Continuing Education on Primary Healthcare Physicians' Knowledge, Attitudes, and Practices

BACKGROUND

Little is known about the impact of diabetes mellitus (DM) continuing education (CE) programs on the knowledge, attitudes, and practices of primary healthcare physicians (PHPs) in the Arab world. Accordingly, we aimed to evaluate the effectiveness of a diabetes CE program on the knowledge, attitudes and practices of PHPs in Aseer region, Saudi Arabia.

METHODS

This was a quasi-experimental study using a pre-test and post-test design. PHPs attended a three-day diabetes CE session and completed a standardized questionnaire before and after the training session. Also, their practices were assessed by reviewing the records of patients with DM before the CE program and three months later.

RESULTS

A total of 51 PHPs completed the CE program. The sample had a mean (± SD) age of 33.8 ± 6.0 years, and 72.5% were male. The mean knowledge score increased from 14.33 (± 3.37) to 17.61 (± 2.57) (p < 0.001), and the rate of good knowledge increased from 39 (76.5%) before to 51 (100.0%) after (p < 0.001). There was no significant difference in the mean attitude scores before and after the intervention (3.79 vs 3.86; p = 0.10), respectively. Overall, PHPs' practices related to glycosylated hemoglobin estimation (p = 0.004), foot care (p = 0.02), diet (p < 0.001), exercise (p <0.001), and weight assessment (p < 0.001) significantly improved following the intervention.

CONCLUSION

The CE program for PHPs was effective in addressing knowledge gap of PHPs and in improving their practices towards quality patient care.

Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education

BACKGROUND

To explore the impact of an online continuing medical education (CME) program on physicians' knowledge about the management of type two diabetes.

METHODS

An online CME program was designed and uploaded in the CME platform, Department of Education, Ministry of health, Iran. A 28-item questionnaire was used for the assessment. In the beginning, a case scenario was introduced. Then, participants were asked to follow and answer to a pretest assessment. Details of the educational content were provided afterward. Finally, the participants took part in the same post-test exam 4 weeks later. The Wilcoxon matched-pairs signed-ranks test was used to compare the measurements. In addition, the Mann-Whitney test was applied to compare knowledge indices between the general practitioners (GPs) and internists.

RESULTS

Five hundred twenty-six primary care physicians participated in this study. There was a significant positive effect regarding diagnosis confirmation (10.3% difference, P = 0.0001). Moreover, a smaller effect was observed in relation to the importance of glycosylated hemoglobin (HbA1c) at diagnosis (5.2% difference, P = 0.0006). The effect was positive in relation to the self-reported HbA1c testing frequency: more than 90% of the participants answered correctly in the post-test exam (7.6% difference, P = 0.0001). Considering improved knowledge in the treatment of diabetes, there was a very significant difference in response to questions targeting advice on a healthy diet, and physical activity; 27.7% (P = 0.000), and 18.7% (P = 0.000), respectively. In addition, the program had a positive impact on various aspects of treatment with oral glucose-lowering drugs (OGLDs). Moreover, the intervention difference was 25, and 34.4% for the questions targeting the appropriate type of insulin, and insulin initiation regimen after OGLD failure. Subgroup analyses revealed that the intervention increased the rate of correct responses among the GPs in various domains of knowledge in diagnosis and treatment. The initial differences between the GPs and internists no longer remained significant after the intervention.

CONCLUSION

Knowledge of Iranian primary health care professionals in diabetes management has significant shortcomings. This is concerning because they are at the front line of patient care. We demonstrate the effectiveness of online CME on improving GPs knowledge in the management of type 2 diabetes.

Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement

Background:

The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision.

Methods:

This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics.

Results:

Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel ‘personalized care’, ‘one-stop-centre’ and utilization of patients’ waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance.

Conclusion:

We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources – a potential that may be tapped into by systematic learning from ongoing innovation.