Designing tailored Web-based instruction to improve practicing physicians' chlamydial screening rates

Linda Casebeer, Jeroan Allison, Claire M Spettell
Academic Medicine 2002, 77 (9): 929

OBJECTIVE: To design an individualized Web-based continuing medical education (CME) program to improve practicing physicians' chlamydial screening rates.

DESCRIPTION: Often unrecognized and untreated, chlamydial infections in young women may cause pelvic inflammatory disease, infertility, and ectopic pregnancy and facilitate the acquisition of HIV. The National Committee for Quality Assurance in 2001 reported chlamydia screening rates to be 23.6% for 16-20-year-olds and 18.3% for 21-26-year-olds. In a collaborative project an academic medical center and a large national managed care organization have developed four tailored Web-based modules for primary care physicians with the goal of improving rates of screening for chlamydia. Each module includes: (1) individual office chlamydial screening rates; (2) interactive cases with real-time comparison of answers with those of peers; (3) a toolbox of office support materials, including patient education materials and guideline summaries; and (4) real-time tailoring of the Web pages based on physicians' interactions with module. Readiness to change and barriers impeding change are assessed during interaction with the module and multiple pathways are created in real time for each physician. Physicians' perceptions of the prevalence of chlamydia in their patient populations and the rate of sexual activity among adolescent girls are also assessed. These variables have been correlated in other studies with low rates of chlamydial screening. Inaccurate perceptions of these variables are considered to constitute a precontemplative stage of change. Specific messages are designed to facilitate increased awareness of chlamydia prevalence, level of sexual activity, and the consequences of failure to screen. For physicians who are aware of the nature and scope of the problems related to chlamydia, messages are tailored to assist them in reducing barriers to screening. A randomized trial of a national sample of primary care physicians is being conducted to determine the effectiveness of this intervention in improving physicians' chlamydial screening rates in sexually active women 16-26 years of age.

DISCUSSION: While the Internet offers an educational distribution system accessible to practicing physicians, most CME online programs are text-based and infrequently interactive or guideline-based. It is unlikely that these programs have broad impact on physicians' practice patterns. Neither the broad capacities of Web technologies nor the evidence of effective methods for influencing physicians' practice patterns has influenced the design of most CME programs. The innovative course described above provides individual office feedback on performance, compares physicians' responses with those of their peers, gathers responses to determine physicians' readiness to change practices, and provides branching pathways "on-the-fly" individualized to these responses. The module format is easily adapted to other diseases, able to be linked in an automated fashion to administrative data files, and relatively low in cost to support.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"