Monday, September 15, 2014

How do you keep docs up to date on changing care standards? Don’t send a tool kit

TORONTO — A new study reports that an educational tool kit sent to bring doctors up to date on changed recommendations for heart-health care for diabetes seems to have failed.
In fact, the tool kit may have backfired, with the patients of doctors who received it actually doing poorer on heart-health measures than patients whose doctors didn’t receive the kit.

The tool kit was created by the Canadian Diabetes Association after it updated its guidelines on how to care for diabetics in 2008.
The following year it sent out the materials to advise doctors of key changes related to caring for the cardiovascular health of diabetics, who have an elevated risk of heart disease.
Some Ontario researchers designed a study to see what effect on care the tool kit would have and got the diabetes association to send it to some medical practices in 2009 and others in 2010.
When they compared how the diabetics in the two groups of practices were doing, the researchers did not find that those whose doctors had received the educational material were in better cardiovascular health.
If anything, the patients whose doctors had received the tool kit were doing less well than the patients whose doctors hadn’t yet received the material, says lead author Dr. Barium Shah, a scientist with the Institute for Clinical Evaluative Sciences in Toronto.
Other studies have shown that sending doctors printed education materials has limited benefit.
But the fact that the findings trended toward the negative “is unexpected,” says the study, published Tuesday in the journal PLoS Medicine.
The authors say the findings may have been chance — in effect untrue.
But Shah theorizes that the tool kit focused the doctors’ attention on diabetes, not specifically the cardiac care of diabetics. His thinking goes that instead of concentrating on things like control of high blood pressure in diabetics, the tool kits made the doctors even more concerned about controlling their diabetic patients’ blood sugar levels.
“For diabetes in particular, I think there’s too much focus on blood sugars and too much obsession about fine-tuning blood sugars and forgetting about the bigger picture,” says Shah, who is also an endocrinologist at Toronto’s Sunnybrook Health Sciences Centre.
The study was funded by the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Canada.

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