Background
Methods
Design
Intervention: continuing medical education meeting
Outcomes
Practice population
Patient populations
Variables
Statistical analyses
Results
Study population
Reference group | CME-M group | |||
---|---|---|---|---|
Study base, Practices, N
| 248 | 148 | ||
Proportion of solo practices (95% CI) | 0.60 (0.54;0.66) | 0.30 (0.23;0.38) | ||
GPs per practice, mean (range) | 1.72 (1–5) | 2.60 (1–10) | ||
GPs, N
|
425
|
385
| ||
Proportion of males (95% CI) | 0.59 (0.54;0.64) | 0.48 (0.43;0.53) | ||
Mean age (95% CI) | 52.6 (51.7;53.4) | 51.6 (50.8;52.4) | ||
Underlying practice populations, N
| 661,805 | 570,926 | ||
Mean list size, patients ≥ 40 yrs. per practice | 1353 | 1920 | ||
Mean list size, patients ≥ 40 yrs. per GP in practice | 787 | 738 | ||
Proportion of male patients aged ≥ 40 yrs. (95% CI) | 0.50 (0.49;0.50) | 0.48 (0.47;0.49) | ||
Age groups (yrs.), proportion of all patients ((%)(95% CI)) | ||||
0–39 | 48.6 (47.4; 49.9) | 49.9 (48.4; 51.3) | ||
40–49 | 14.1 (13.8;14.4) | 14.0 (13.7;14.4) | ||
50–59 | 13.4 (13.0;13.7) | 12.7 (12.2;13.1) | ||
60–69 | 12.5 (12.0;12.9) | 12.1 (11.6;12.6) | ||
70–79 | 7.3 (6.9;7.6) | 7.2 (6.8;7.6) | ||
80–90
| 3.5 (3.3; 3.7) | 3.4 (3.2; 3.6) | ||
Above 90 | 0.76 (0.7; 0.8) | 0.73 (0.7; 0.8) | ||
Mean DADI index (95% CI) | 26.9 (25.9;27.8) | 25.5 (24.4;26.5) | ||
Referred patients (age ≥ 40 yrs.) |
Before CME-M, N = 8,388
|
After CME-M,
N = 8,534
|
Before CME-M,
N = 7,579
|
After CME-M,
N = 7,942
|
Proportion of males (95% CI) | 0.47 (0.45;0.48) | 0.45 (0.44;0.46) | 0.44 (0.43;0.46) | 0.44 (0.43;0.45) |
Mean age (95% CI) | 63.0 (62.7;63.3) | 63.1 (62.9;63.4) | 62.6 (62.3;62.9) | 62.8 (62.5;63.1) |
Comorbiditya (%) | ||||
None | 75.5 | 74.8 | 76.2 | 75.2 |
Medium | 20.9 | 21.3 | 19.9 | 21.0 |
High | 3.6 | 3.9 | 3.9 | 3.8 |
Reference group | CME-M group | |||
---|---|---|---|---|
Practices, N
| 240 | 144 | ||
Proportion of solo practices (95% CI) | 0.60 (0.54;0.66) | 0.29 (0.22;0.37) | ||
GPs per practice, mean (range) | 1.73 (1–5) | 2.63 (1–10) | ||
GPs, N
| 415 | 377 | ||
Proportion of males (95% CI) | 0.60 (0.55;0.64) | 0.48 (0.43;0.53) | ||
Mean age (95% CI) | 52.9 (52.0;53.7) | 51.7 (50.9;52.5) | ||
Referred patients (age ≥ 40 yrs.), N
|
Before CME-M, N = 7,659
|
After CME-M, N = 7,731
|
Before CME-M, N = 7,121
|
After CME-M, N = 7,417
|
Proportion of males (95% CI) | 0.46 (0.45;0.47) | 0.46 (0.45;0.47) | 0.44 (0.43;0.46) | 0.44 (0.43;0.45) |
Mean age (95% CI) | 63.1 (62.8;63.4) | 63.2 (62.9;63.5) | 62.7 (62.4;63.0) | 62.9 (62.6;63.2) |
Comorbidity (%)a
| ||||
None | 75.9 | 75.3 | 76.4 | 75.7 |
Medium | 20.7 | 21.1 | 19.8 | 20.8 |
High | 3.4 | 3.6 | 3.8 | 3.6 |
Mean habitual F2F monthly contact rateb (95% CI) | 0.60 (0.58;0.61) | 0.57 (0.56;0.59) | 0.61 (0.59;0.62) | 0.60 (0.58;0.61) |
Mean habitual total monthly contact rateb (95% CI) | 1.05 (1.03;1.08) | 1.02 (1.00;1.05) | 1.07 (1.05;1.10) | 1.04 (1.01;1.06) |
Reference group | CME-M group | |||
---|---|---|---|---|
Practices, N (proportion of study base %) | 199 (82.9%) | 139 (93.9%) | ||
Proportion of solo practices (95% CI) | 0.53 (0.46;0.60) | 0.26 (0.19;0.35) | ||
GPs per practice, mean (range) | 1.85 (1–5) | 2.66 (1–10) | ||
GPs, N
| 369 | 370 | ||
Proportion of males (95% CI) | 0.57 (0.52;0.62) | 0.47 (0.42;0.53) | ||
Mean age (95% CI) | 52.1 (51.2;53.0) | 51.4 (50.6;52.2) | ||
Total referred patients during 8 months (age ≥ 40 yrs.) |
Before CME-M, N = 5,749
|
After CME-M, N = 4,607
|
Before CME-M, N = 4,935
|
After CME-M, N = 5,303
|
Proportion of males (95% CI) | 0.46 (0.45;0.47) | 0.45 (0.44;0.47) | 0.44 (0.43;0.46) | 0.44 (0.43;0.46) |
Mean age (95% CI) | 62.8 (62.5;63.1) | 63.0 (62.6;63.4) | 62.5 (62.1;62.8) | 62.8 (62.5;63.2) |
Comorbidity (%) | ||||
None | 75.3 | 74.7 | 75.8 | 74.8 |
Medium | 20.7 | 21.3 | 19.9 | 21.2 |
High | 4.0 | 4.0 | 4.3 | 3.9 |
Referred patients with known primary care intervals (age ≥ 40 yrs.) (Response (%)) |
Before CME-M, N = 1,227
(21.3%)
|
After CME-M, N = 753
(16.3%)
|
Before CME-M, N = 990
(20.0%)
|
After CME-M, N = 1,102
(20.8%)
|
Proportion of males (95% CI) | 0.52 (0.49;0.55) | 0.54 (0.50;0.57) | 0.48 (0.45;0.51) | 0.47 (0.44;0.50) |
Mean age (95% CI) | 64.9 (64.2;65.6) | 64.5 (63.6;65.3) | 64.5 (63.8;65.3) | 64.8 (64.1;65.5) |
Comorbiditya (%) | ||||
None | 76.7 | 75.4 | 76.1 | 75.6 |
Medium | 19.7 | 20.2 | 20.1 | 21.0 |
High | 3.6 | 4.4 | 3.8 | 3.4 |
Cancer detection difficultyb (%) | ||||
Easier to detect | 72.2 | 68.4 | 69.2 | 70.2 |
Harder to detect | 23.1 | 25.4 | 26.4 | 24.9 |
Missing information | 4.6 | 6.2 | 4.4 | 4.9 |
Impact of CME-M on urgent referral rates
Reference group | CME-M group | Comparison between groups | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Before CME-M | After CME-M | Before vs. after | Before CME-M | After CME-M | Before vs. after | ||||||||
∆0 | IRR0b (95% CI) | P | ∆1 | IRR1b (95% CI) | P | ∆1/∆0 | IRR1/IRR0b
(95% CI) | P | |||||
All data, N practices (GPs) | 248 (425) | - | 148 (385) | - | - | - | - | ||||||
Referral ratea per GP, mean | 20.4 | 20.8 | 0.4 | 1.02c (0.98;1.05) | 0.316 | 20.6 | 21.4 | 0.8 |
1.05
c
(1.01;1.08)
|
0.009
| 2.0 | 1.03c (0.98;1.08) | 0.214 |
Referral ratea per 1000 patients, mean | 25.0 | 25.3 | 0.3 | 1.01c (0.98;1.05) | 0.435 | 27.1 | 28.1 | 1.0 | 1.04c (0.99;1.08) | 0.111 | 3.3 | 1.02c (0.97;1.08) | 0.454 |
Single-handed practices, N practices (GPs) | 149 (149) | - | 45 (45) | - | - | - | - | ||||||
Referral ratea per GP, mean | 21.3 | 21.7 | 0.4 | 1.02 (0.96;1.08) | 0.481 | 24.0 | 23.9 | −0.1 | 0.99 (0.89;1.09) | 0.796 | −0.25 | 0.97 (0.86;1.08) | 0.566 |
Referral ratea per 1000 patients, mean | 24.2 | 24.3 | 0.1 | 1.01 (0.95;1.07) | 0.763 | 26.9 | 26.2 | −0.7 | 0.98 (0.88;1.08) | 0.626 | −7.0 | 0.97 (0.86;1.09) | 0.567 |
Partnership practices, N practices (GPs) | 99 (276) | - | 103 (340) | - | - | - | - | ||||||
Referral ratea per GP, mean | 18.9 | 19.3 | 0.4 | 1.02 (0.97;1.05) | 0.540 | 19.0 | 20.2 | 1.2 |
1.06 (1.02;1.10)
|
0.002
| 3.0 | 1.04 (0.99;1.10) | 0.105 |
Referral ratea per 1000 patients, mean | 26.3 | 26.9 | 0.6 | 1.02 (0.97;1.08) | 0.457 | 27.2 | 28.9 | 1.7 |
1.06 (1.01;1.12)
|
0.019
| 2.8 | 1.04 (0.97;1.12) | 0.280 |
Impact of CME-M on prior contacts
Reference group
N = 240 practices | CME-M group
N = 144 practices | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
N patients | Before CME-M 7,659 | After CME-M 7,731 | Before vs. after | Before CME-M 7,121 | After CME-M 7,417 | Before vs. after | Comparison between groups | |||
Prior contacts | IRR0a (95% CI) | P | IRR1a (95% CI) | P | IRR1/IRR0a (95% CI) | P | ||||
F2F contacts (mean) | ||||||||||
0–1 month | 1.91 | 1.89 | 1.00 (0.98;1.02) | 0.662 | 1.92 | 1.90 | 0.99 (0.97;1.01) | 0.190 | 0.99 (0.96;1.02) | 0.525 |
0–3 months | 3.24 | 3.20 | 1.00 (0.98;1.02) | 0.868 | 3.23 | 3.22 | 1.00 (0.98;1.02) | 0.950 | 1.00 (0.97;1.03) | 0.872 |
4–6 months | 1.82 | 1.81 | 1.01 (0.98;1.05) | 0.536 | 1.84 | 1.83 | 0.99 (0.96;1.03) | 0.870 | 0.99 (0.94;1.04) | 0.583 |
Total contacts (mean) | ||||||||||
0–1 month | 2.84 | 2.87 | 1.01 (0.99;1.03) | 0.189 | 2.95 | 2.87 |
0.98 (0.94;0.99)
|
0.044
|
0.97 (0.94;0.99)
|
0.019
|
0–3 months | 5.17 | 5.21 | 1.01 (0.99;1.03) | 0.233 | 5.31 | 5.19 | 0.99 (0.97;1.02) | 0.369 | 0.98 (0.95;1.01) | 0.137 |
4–6 months | 3.22 | 3.24 | 1.00b (0.97;1.04) | 0.980 | 3.27 | 3.21 | 0.97b (0.94; 1.01) | 0.138 | 0.97b (0.93;1.02) | 0.296 |
Most contacting patients in the month preceding referral | OR0a (95% CI) | P | OR1a (95% CI) | P | OR1/OR0a (95% CI) | P | ||||
F2F contacts ≥ 4c (%) | 10.4 | 10.4 | 1.02 (0.92;1.14) | 0.726 | 10.8 | 10.8 | 0.99 (0.89;1.11) | 0.911 | 0.97 (0.84;1.14) | 0.745 |
Total contacts ≥ 5c (%) | 16.9 | 17.2 | 1.04 (0.95;1.13) | 0.426 | 18.5 | 17.5 | 0.94 (0.86;1.02) | 0.148 | 0.90 (0.86;1.02) | 0.112 |
Impact of CME-M on primary care intervals
Reference group
N = 199 practices | CME-M group
N = 139 practices | Comparison between groups | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Before CME-M | After CME-M | Before vs. after | Before CME-M | After CME-M | Before vs. after | |||||
OR0a (95% CI) | P | OR1a (95% CI) | P | OR1/OR0a (95% CI) | P | |||||
All data, N patients
|
1,227
|
753
|
-
|
990
|
1,102
|
-
|
-
| |||
PCI, median days (percentiles: 75th, 90th) | 1 (13, 43) | 1 (12, 46) | - | 1 (14, 42) | 1 (17, 53) | - | - | |||
PCI ≥ baseline 75th percentilec % | 25.8 | 24.4 | 0.812 (0.63;1.04) | 0.099 | 25.1 | 27.9 | 1.19b (0.95;1.49) | 0.135b
|
1.47
b
(1.06;2.03)
|
0.021
|
PCI ≥ baseline 90th percentilec % | 10.1 | 10.6 | 1.12b (0.79;1.57) | 0.532 | 10.4 | 12.5 | 1.27b (0.92;1.74) | 0.146 | 1.13b (0.72;1.78) | 0.583 |
Easier to detect, N patients
|
887
|
515
|
-
|
685
|
774
|
-
|
-
| |||
PCI, median days (percentiles: 75th, 90th) | 0 (8, 34) | 0 (7, 35) | - | 0 (7, 35) | 0 (9, 41) | - | - | |||
PCI ≥ baseline 75th percentilec % | 26.2 | 23.9 | 0.87 (0.66;1.15) | 0.345 | 27.2 | 29.7 | 1.18 (0.92;1.52) | 0.187 | 1.35 (0.94;1.94) | 0.101 |
PCI ≥ baseline 90th percentilec % | 10.5 | 10.1 | 0.97 (0.66;1.44) | 0.888 | 10.2 | 11.9 | 1.24 (0.87;1.77) | 0.241 | 1.27 (0.76;2.12) | 0.353 |
Hard to detect, N patients
|
284
|
191
|
-
|
261
|
274
|
-
|
-
| |||
PCI, median days (percentiles: 75th, 90th) | 7 (26.5, 71) | 5 (28, 79) | - | 7 (27, 58) | 8 (30, 80) | - | - | |||
PCI ≥ baseline 75th percentilec % | 25.0 | 25.7 | 1.12 (0.69;1.79) | 0.653 | 25.7 | 30.3 | 1.35 (0.87;2.08) | 0.180 | 1.21 (0.66;2.21) | 0.543 |
PCI ≥ baseline 90th percentilec % | 10.2 | 11.5 | 1.20 (0.62;2.34) | 0.584 | 10.3 | 13.1 | 1.34 (0.73;2.46) | 0.348 | 1.11 (0.48;2.59) | 0.805 |