MANUSCRIPT: Intended Practice Changes and Barriers among Primary Care Providers

Background. The purpose of accredited CME has recently been enhanced to change competence, performance or patient outcomes. In addition, CME providers seeking accreditation with commendation are required to implement educational strategies to remove, overcome or address barriers to physician change. However, current methods to measure intended changes in practice and barriers to these changes are limited.
Method. At a free-standing annual Family Medicine review, we administered a -specific instrument asking learners to list intended practice changes related to 3 specific high-impact content areas (reducing error, emerging infections, and contraception for women with medical co-morbidities), score their likelihood of implementing each of these changes (1=very unlikely to l0 very likely), identify perceived barriers to each change, and identify their strategies to overcome these barriers. We analyzed the results and discussed them with learners on the last day of the course.
Results. Our response rate was 30.8%. For the 3 content areas, the mean number of changes per respondent ranged from 1.8 to 2.2, and for 72% of the intended practice changes, the likelihood of implementing them was >/= 8. For all 3 content areas, physicians’ remembering and breaking old habits were commonly-cited, but for reducing error numerous other barriers were also perceived. To overcome these barriers, the most commonly cited strategies were decision support techniques. In addition, for reducing error, additional commonly-cited approaches were more team communication and training and systems changes.
Conclusion. Using a targeted evaluation, we were able to go beyond knowledge and satisfaction and analyze intended practice changes and perceived barriers to change. For some content areas (such as emerging infections or contraception), the most commonly-cited barriers were directly physician related whereas for a more complex content area (such as reducing error), additional barriers were perceived. These findings emphasize the importance of CME providers building bridges with other stakeholders who can influence changes in practice.

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