PDF(Pubmed)
Abstract：
BACKGROUND: Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps.
METHODS: This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis.
RESULTS: Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners\' incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001).
CONCLUSIONS: This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
METHODS: This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis.
RESULTS: Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners\' incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001).
CONCLUSIONS: This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.
摘要：
背景：视网膜疾病，包括湿性或干性年龄相关性黄斑变性，糖尿病性黄斑水肿,和糖尿病视网膜病变（DR），在美国被诊断和治疗不足。临床试验支持抗血管内皮生长因子（抗VEGF）治疗几种视网膜疾病的有效性，但是现实世界的数据表明临床医生的使用不足，导致患者经历较差的视觉结果随着时间的推移。继续教育(CE)在改变实践行为方面表现出了有效性，但需要更多的研究来了解CE是否可以帮助解决诊断和治疗差距。
方法：该测试和对照配对分析检查了10,786名医疗保健从业人员中的视网膜疾病和基于指南的筛查和干预的测试前/测试后知识（即视网膜专家，眼科医生,验光师,初级保健提供者，糖尿病教育者，药剂师/管理护理专家，和其他医疗保健提供者，比如注册护士，执业护士,和医师助理)参与模块化，互动CE倡议。另一项医疗索赔分析提供了有关实践变化的数据，评估视网膜专家和眼科医生学习者（n=7,827）在教育前/后使用VEGF-A抑制剂，与匹配的非学习者对照组相比。结果是测试前/测试后知识/能力的变化和抗VEGF治疗应用的临床变化，正如医疗索赔分析所确定的那样。
结果：学习者在早期识别和治疗方面的知识/能力得分显著提高，确定可以从抗VEGF药物中受益的患者，使用指南推荐的护理，认识到筛查和转诊的重要性，并认识到早期发现和护理DR的重要性（所有P值=0.003至0.004）。与匹配的对照相比，在CE干预后，学习者对视网膜疾病的抗VEGF药物的总注射量增加更多(P<0.001)；特别是，与非学习者相比，处方的（新的）抗VEGF注射增加了18,513次（P<0.001）。
结论：这种模块化，互动式,沉浸式CE计划在视网膜疾病护理提供者中带来了显著的知识/能力提升，并改变了与实践相关的治疗行为(即，与匹配的对照组相比，参与的眼科医生和视网膜专家适当考虑并更多地纳入指南推荐的抗VEGF治疗）。未来的研究将利用医疗索赔数据来显示该CE计划对专家治疗行为的纵向影响，以及对参与未来计划的验光师和初级保健提供者的诊断和转诊率的影响。
方法：该测试和对照配对分析检查了10,786名医疗保健从业人员中的视网膜疾病和基于指南的筛查和干预的测试前/测试后知识（即视网膜专家，眼科医生,验光师,初级保健提供者，糖尿病教育者，药剂师/管理护理专家，和其他医疗保健提供者，比如注册护士，执业护士,和医师助理)参与模块化，互动CE倡议。另一项医疗索赔分析提供了有关实践变化的数据，评估视网膜专家和眼科医生学习者（n=7,827）在教育前/后使用VEGF-A抑制剂，与匹配的非学习者对照组相比。结果是测试前/测试后知识/能力的变化和抗VEGF治疗应用的临床变化，正如医疗索赔分析所确定的那样。
结果：学习者在早期识别和治疗方面的知识/能力得分显著提高，确定可以从抗VEGF药物中受益的患者，使用指南推荐的护理，认识到筛查和转诊的重要性，并认识到早期发现和护理DR的重要性（所有P值=0.003至0.004）。与匹配的对照相比，在CE干预后，学习者对视网膜疾病的抗VEGF药物的总注射量增加更多(P<0.001)；特别是，与非学习者相比，处方的（新的）抗VEGF注射增加了18,513次（P<0.001）。
结论：这种模块化，互动式,沉浸式CE计划在视网膜疾病护理提供者中带来了显著的知识/能力提升，并改变了与实践相关的治疗行为(即，与匹配的对照组相比，参与的眼科医生和视网膜专家适当考虑并更多地纳入指南推荐的抗VEGF治疗）。未来的研究将利用医疗索赔数据来显示该CE计划对专家治疗行为的纵向影响，以及对参与未来计划的验光师和初级保健提供者的诊断和转诊率的影响。
