What Clinicians Know. . . After CME

Merry-K. MoosProfessor (retired)

Department of Obstetrics and GynecologyUniversity of North Carolina

mkmoos@med.unc.edu

Sponsorship and Partnership for www.beforeandbeyond

Content managers: Merry-K. Moos (UNC) and Peter Bernstein (Einstein)

Technical support and “home base” UNC Center for Maternal-Infant Health and Dennis Rodriguez

CME support: Albert Einstein College of Medicine

Financial support: Almost none--Mostly donated time and resources

Purpose

Impact the knowledge and clinical practices of the most providers possible in order to help women and families achieve high levels of preconceptional health

CME Courses Created for Site

Preconception Care: What It is and What It Isn’t

Every Woman, Every Time Maximizing Prevention: Targeted Care for

Those with High Risk Conditions

Features

Free 1.5 AMA Category 1 CME credits (appropriate to physicians, advanced practice nurses and physician assistants) awarded through Albert Einstein College of Medicine

Each module has 7 post test questions; passing grade is 70% (which requires 5 correct responses)

Except for first module, the education combines fact and case-based learning

All modules include some limited interactivity

Use and Credit

Launched late Fall, 2008 To date, 3,904 hits on Modules Page (18,602 hits on

home page) Credit was attempted and achieved by the following

numbers Preconception Care: What It is and What It Isn’t: 124

individuals/54.8% passed Every Woman, Every Time: 31 individuals/77% passed Maximizing Prevention: Targeted Care for Those with High

Risk Conditions: 18 individuals/94.4% passed

PRECONCEPTION CARE: WHAT IT IS and

WHAT IT ISN’TThe National Preconception Curriculum &

Resources Guide for CliniciansMODULE 1

Reviewed and updated on November 4, 2009Release Date: December 1, 2009

Termination Date: December 1, 2010

CME sponsored by Albert Einstein College of Medicine, New YorkNext

Module 1: What It Is and What It Isn’t

People who completed module and took post test: 124 (54.8% passed)—3 didn’t complete test; have data on 114

-MDs: 9 (44% passed) includes ob/gyns, gyns, psychiatrist, pediatric hospitalist, etc

-NPs and CNMs*: 35 (43% passed)-RNs: 50 (60% passed)-Others: 20 (70% passed) includes

pharmacist, community health educators, students, general studies in cello (!), social worker, etc.

Question 1: What % of NTDs are considered preventable by adequate intake of folic acid?

a: 90-100%

b: 75-90%

c: 50-70%

d: 20-30%

Slide from Module: EXAMPLES OF PRIMARY PREVENTION of Congenital Anomalies

Prevention of neural tube defects

Birth Defects related to poor glycemic control of mother (including sacral agenesis, cardiac defects and neural tube defects)

50-70% of NTDs can be prevented if a woman has adequate levels of folate during earliest weeks of organogenesis

Can be reduced from 10% to 2-3% through glycemic control of the mother before organogenesis

Next

Question 1: What % of NTDs are considered preventable by adequate intake of folic acid?

a: 90-100%

b: 75-90%

c: 50-70%d: 20-30%

60% of participants answered correctly

Question 3: The CDC definition of preconception care is:

a. a single visit for women when they stop using a method of contraception

b. more than a single visit and less than all well woman care

c. a series of special visits for all women to assure the highest level of health achievable before conception

d. all of well woman care for all women between ages 15-45

Slide From Module: CDC Definition of Preconception Care

Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral and social risks to a woman’s health or pregnancy outcome through prevention and management

It is more than a single visit and less than all well-woman care

CDC and Select Panel, 2006 Next

Question 3: The CDC definition of preconception care is:

a. a single visit for women when they stop using a method of contraception

b. more than a single visit and less than all well woman care

c. a series of special visits for all women to assure the highest level of health achievable before conception

d. all of well woman care for all women between ages 15-45

47% of participants answered correctly

Question 6: By promoting higher levels of health for all women who might someday conceive, which of the following could be achieved.

a. higher levels of wellness for women

b. higher levels of preconceptional wellness should the woman conceive

c. better pregnancy outcomes for mothers and infants.

d. all of the above are possible but not proven

e. none of the above

Slide from ModuleSlide from Module: Potential Advantages of : Potential Advantages of Regularly Addressing these Issues with Every Regularly Addressing these Issues with Every Woman Who Might Woman Who Might SomeSomeday Conceiveday Conceive

Higher levels of wellness for the woman Higher levels of preconceptional health should a woman become pregnant Improved pregnancy outcomes Likely higher rates of pregnancy intendedness for those who become pregnant

Next

Question 6: By promoting higher levels of health for all women who might someday conceive, which of the following could be achieved.

a. higher levels of wellness for women

b. higher levels of preconceptional wellness should the woman conceive

c. better pregnancy outcomes for mothers and infants.

d. all of the above are possible but not provene. none of the above

40% of participants answered correctly

Every Woman, Every Time: Integrating Preconceptional

Health into Routine CareThe National Preconception Curriculum &

Resources Guide for CliniciansMODULE 2

Release Date: December 9, 2009Termination Date: December 31, 2010

Sponsored by Albert Einstein College of Medicine and Montefiore Medical Center in joint sponsorship with the University of North Carolina Center for Maternal & Infant Health.

Next

Case Study 1: LisaCase Study 1: Lisa

Lisa is a 24 yo presenting for her annual exam and contraceptive care. When reviewing her

history and pre-exam assessments, you uncover the following:

Next

What Are Specific Issues that Lisa’s Profile What Are Specific Issues that Lisa’s Profile Suggests Need Attention?Suggests Need Attention?

Routine Health Promotion Issues?• Click here for a list of routine health promotion

issues that are important for Lisa, whether she ever becomes pregnant or not

Specific Preconception Issues?• Click here for a list of preconception topics that

are important for Lisa

Next

Module 2: Every Woman, Every Time

People who completed module and took post test: 31 (77% passed)

-MDs: 3 (66% passed) -NPs and CNMs*: 7 (71% passed)

-RNs: 16 (81% passed)

-Others: 5 (80% passed)

Maximizing Prevention: Targeted Care for Those with

High Risk ConditionsThe National Preconception Curriculum &

Resources Guide for CliniciansMODULE 3

Release Date: December 1, 2009Termination Date: December 1, 2010

CME sponsored by provided by Albert Einstein School of MedicineNext

Slide from Module 3: High Risk Slide from Module 3: High Risk ConditionsConditionsCase Study: Chronic HypertensionCase Study: Chronic Hypertension

32 yo social worker who was diagnosed with 32 yo social worker who was diagnosed with chronic hypertension 3 years agochronic hypertension 3 years ago

Presents for an annual visit, not currently Presents for an annual visit, not currently taking any medicationstaking any medications

BP at visit is 160/100BP at visit is 160/100 Does not desire a pregnancy in the near Does not desire a pregnancy in the near

future but is getting married in 2 monthsfuture but is getting married in 2 months

Next

Slide from Module 3: High Risk ConditionsSlide from Module 3: High Risk ConditionsPreconception Care Goals: Chronic Preconception Care Goals: Chronic HypertensionHypertension

Implications for the woman if she Implications for the woman if she conceives (click here)conceives (click here)

Implications for pregnancy outcome if she Implications for pregnancy outcome if she conceives (click here)conceives (click here)

Medication considerations (click here)Medication considerations (click here) Family planning needs (click here)Family planning needs (click here) Looking beyond the disease to the whole Looking beyond the disease to the whole

woman (click here)woman (click here) Next

Module 3: Targeted Care for High Risk Conditions

People who completed module and took post test: 18 (94.4% passed)

-MDs: 1 (100% passed) -NPs and CNMs*: 2 (50% passed)

-RNs: 10 (100% passed)

-Others: 5 (100% passed)

What Do These Findings Suggest? People may not want on-line CME People may take the exams without studying the content That the best pass rates were associated with the least formal

education suggests the more highly educated are the least amenable to learning in this format

The content/tests may be of poor quality (although they were refereed the results are disappointing. . .and we thought the tests were easy)

The “n”s may be too small to make any conclusions Changing knowledge to change practice behaviors will take far

more than online CME offerings Others???

Recent Improvements in Traffic and Pass Rates

Mid-March, 2011 Module 1: 124

completed/55% passed Module 2: 31

completed/67.7% passed Module 3: 18

completed/17 passed

June 6, 2011 Module 1: 167

completed/64.7% passed Module 2: 71 completed/

83.1% passed Module 3 unchanged