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1. Knowledge and health care resource allocation: CME/CPD course guidelines-based efficacy

Author

Braido, F., Comaschi, M., Valle, I., Delgado, L., Coccini, A., Guerreras, P., Stagi, E., Canonica, G. W., Arga, Study Group, Eaaci Cme, Committee, Angino, A., Baldacci, S., Borbotti, M., Cerrai, S., Di Pede, F., Maio, S., Mangione, M., Martini, F., Pala, P., Piegaia, B., Sarno, G., Silvi, P., Viegi, G., Dente, F., Bacci, E., Paggiaro, P., Bancalari, L., Foschino, M. P., Moscato, G., Pilucchi, A., Bresciani, M., Pierimarchi, P., Brunetto, B., Iacovacci, P., Pini, C., Tinghino, R., Forestiere, F., Perucci, C. A., Porta, D., Ancona, L., Protasi, S., Lazazzera, B., Ziroli, V., D Armini, E., Festa Campanile, S., Ferri, M., Lorusso, P., Pistelli, R., Salotti, R., Santagati, M., Casciari, C., Murgia, N., Spinozzi, F., Antonicelli, L., Braschi, M. C., Conti, V., Filippelli, A., Corbi, G. M., Giusy Russomanno, Baiardini, I., Balbi, F., Ferraioli, G., Bordo, A., Cerveri, I., Corsico, A., Grosso, A., Ansotegui, I. J., Gayraud, J., Nekam, K., Malling, H-J, Papadopolus, N., Popov, T., and Skevaki, C.

Subjects
Health Knowledge, Attitudes, Practice, diagnostic procedures, spirometry, continuing medical education, Pilot Projects, Guidelines, drugs, Education, General Practitioners, Medical, cost, Hypersensitivity, Humans, continuing professional development, Rhinitis, Practice, Asthma, hospitalization, medico-economic assessment, Health Knowledge, Continuing, Attitudes, Education, Medical, Continuing, Guideline Adherence
Abstract

Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored.This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management.Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training.Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p0.01).This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events.

Published
2012

2. The ARGA study with general practitioners: Impact of medical education on asthma/rhinitis management

Author

Baldacci, S, Maio, S, Simoni, M, Cerrai, S, Sarno, G, Silvi, P, Di Pede, F, Borbotti, M, Pala, Ap, Bresciani, M, Viegi, G, Angino, Aa, Carrozzi, L, Mangione, M, Martini, F, Piegaia, Bb, Pistelli, F, Cardio Toracico, D, Bacci, E, Bancalari, L, Dente, F, Foschino, Mp, Moscato, Paggiaro, P, Pelucchi, A, Pierimarchi, P, Brunetto, B, Iacovacci, P, Pini, C, Tinghino, R, Forastiere, F, Perucci, Ca, Pistelli, R, Porta, D, Ancona, L, Protasi, S, Lazazzera, B, Ziroli, V, D'Armini, E, Campanile, Sf, Ferri, M, Lorusso, P, Salotti, R, Santagati, M, Agea, E, Casciari, C, Murgia, N, Spinozzi, F, Bonifazi, F, Antonicelli, L, Braschi, Mc, Conti, Valeria, Filippelli, Amelia, Corbi, Gm, Russomanno, G, Braido, F, Canonica, W, Baiardini, I, Francesco, B, Cerveri, I, Corsico, A, Grosso, A., Baldacci, S, Maio, S, Simoni, M, Cerrai, S, Sarno, G, Silvi, P, Di Pede, F, Borbotti, M, Pala, Ap, Bresciani, M, Viegi, G, Corbi, G, and as ARGA study, Group

Subjects
Male, Pediatrics, Asthma treatment, Practice Patterns, Group B, Allergic rhinitis, ARIA guidelines, Asthma, Drugs, GINA guidelines, Prescription adherence, Adult, Anti-Asthmatic Agents, Clinical Competence, Drug Compounding, Family Practice, Female, Glucocorticoids, Guideline Adherence, Histamine Antagonists, Humans, Italy, Middle Aged, Practice Guidelines as Topic, Practice Patterns, Physicians', Program Evaluation, Prospective Studies, Rhinitis, Young Adult, Education, Medical, Continuing, immune system diseases, Pulmonary and Respiratory Medicine, Severe persistent asthma, ARIA guideline, Gina guidelines, GINA guideline, Drug, medicine.medical_specialty, NO, Education, Medical, medicine, Allergic rhiniti, Medical education, Physicians', asthma, business.industry, Mean age, Continuing, medicine.disease, respiratory tract diseases, Concomitant, business
Abstract

Aim: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). Methods: Data on 1820 patients (mean age 41yrs ± 17yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). Results: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. Conclusions: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma. © 2012 Elsevier Ltd. All rights reserved.

Published
2012

3. Impact of asthma and comorbid allergic rhinitis on quality of life and control in patients of italian general practitioners

Author

Maio, S, Baldacci, S, Simoni, M, Angino, A, Martini, F, Cerrai, S, Sarno, G, Pala, A, Bresciani, M, Paggiaro, P, Viegi, G, Alfredo, F, Sergio, N, Anna, S, Alessandro, A, Lucia, B, Diego, B, Francesco, Lf, Giuseppe, Np, Antonietta, Rm, Claudio, A, Marco, C, Mauro, M, Claudia, R, Giuseppina, C, Giovanna, C, Luigi, F, Andreina, F, Maurizio, Dm, Alessandro, Dp, Antonella, La, Davide, R, Mauro, B, Vincenzo, C, Bruno, G, Emiliano, A, Claudio, B, Lorenzo, D, Domenico, M, Giovanni, P, Marinella, P, Gabriella, V, Eliano, B, Marina, C, Khalid, K, Laura, P, Alberto, S, Caterina, T, Renata, T, Gianni, T, Emanuela, R, Mario, Tg, Tiziano, B, Chiara, C, Federica, G, Ivan, V, Eugenio, P, Enrico, C, Riccardo, M, Luigi, M, Filippo, T, Stefano, M, Gabriele, R, Marcello, B, Roberto, C, Donatella, C, Paola, G, Tiziano, L, Paolo, M, Giuliano, P, Michele, V, Roberto, B, Pietro, G, Angelo, M, Salvatore, Sd, Eleonora, T, Vito, A, Cosimo de, M, Donata, F, Gianmario, I, Luigi, L, Giovanna, L, Eugenio, M, Giorgio, M, Michele, M, Vito, M, Marco, M, Giuseppe, M, Pietro, S, Giovanni, S, Carlo, C, Paolo, G, Maria, I, Maria, L, Raffaele, M, Maria, Ng, Raffaele, P, Teodoro, R, Silvia, T, Carmelo, C, Daniele, I, Rita, S, Augusto, V, Nicolò, A, Antonio, B, Domenico, S, Antonio, Sg, Giovanni, Dg, Elio, Ds, Franco, Ag, Gianluigi, S, Raffaellina, S, Francesco, C, Antonio de, B, Arrigo, L, Marco, U, Angino, Aa, Borbotti, M, Carrozzi, L, Di Pede, F, Mangione, M, Pala, Ap, Piegaia, Bb, Pistelli, F, Silvi, P, Bacci, E, Bancalari, L, Dente, F, Foschino, Mp, Moscato, G, Pelucchi, A, Pierimarchi, P, Brunetto, B, Iacovacci, P, Pini, C, Tinghino, R, Forastiere, F, Perucci, Ca, Pistelli, R, Porta, D, Ancona, L, Protasi, S, Lazazzera, B, Ziroli, V, D'Armini, E, Campanile, Sf, Ferri, M, Lorusso, P, Salotti, R, Santagati, M, Agea, E, Casciari, C, Murgia, Nicola, Spinozzi, Fabrizio, Bonifazi, F, Antonicelli, L, Braschi, Mc, Conti, V, Filippelli, A, Corbi, Gm, Russomanno, G, Braido, F, Canonica, W, Baiardini, I, Francesco, B, Cerveri, I, Corsico, A, Grosso, A., Maio, S, Baldacci, S, Simoni, M, Angino, A, Martini, F, Cerrai, S, Sarno, G, Pala, A, Bresciani, M, Paggiaro, P, Viegi, G, Corbi, G, and as ARGA Study, Group

Subjects
Male, Pediatrics, Allergy, Allergies, Asthma, Primary care, Public health, Quality of life, Adolescent, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Family Practice, Female, Humans, Italy, Middle Aged, Prevalence, Quality of Life, Rhinitis, Allergic, Perennial, Surveys and Questionnaires, Young Adult, Pediatrics, Perinatology and Child Health, Immunology and Allergy, Pulmonary and Respiratory Medicine, Disease, 80 and over, Young adult, Rhinitis, education.field_of_study, Perinatology and Child Health, medicine.medical_specialty, education, Population, NO, Allergie, Allergic, medicine, Medical prescription, allergies, asthma, primary care, public health, quality of life, business.industry, medicine.disease, Perennial, Observational study, business
Abstract

Objective. Asthma is a disease with elevated prevalence within the general population. Although general practitioners (GPs) are among the first health-care professionals to whom patients refer for their symptoms, there are few evaluations of this disease based on data provided by the GPs. The aim of this observational study is to assess the impact of asthma and comorbid allergic rhinitis on individual/social burden, quality of life, and disease control in asthmatic patients of Italian GPs. Methods. Throughout Italy, 107 GPs enrolled 995 patients diagnosed with asthma and using anti-asthmatic drug prescriptions, or with asthma-like symptoms during the previous 12 months. Data were collected through questionnaires filled out by GPs and patients. Results. Of the 995 asthmatic patients, 60.6 had concomitant allergic rhinitis (RA), 39.4 had asthma alone. The latter, compared to those with RA, showed significantly lower prevalence of intermittent asthma (37.5 vs. 55.6) and higher prevalence of mild, moderate, and severe persistent asthma (28.4 vs. 23.2, 28.7 vs. 18.8, and 5.4 vs 2.4, respectively). Individual/social burden due to asthma was frequent and increased with disease severity: 87.5 of severe persistent asthma patients reported at least one medical consultation in the last 12 months, 37.5 emergency department visits, 26.7 hospitalization, and 62.5 limitations in daily activities. Control and quality of life were inversely associated with disease severity and were worse in patients with RA than in those with asthma alone. Conclusions. This study showed the negative impact of high severity levels and comorbid allergic rhinitis on quality of life of asthmatic patients and on individual/social burden due to asthma in an Italian GPs setting. © 2012 Informa Healthcare USA, Inc.

Published
2012

4. Knowledge and Health Care resource allocation: CME/CPD course guidelines-based efficacy

Author

Braido, F., Comaschi, M., Valle, I., Delgado, L., Coccini, A., Guerrera, P., Stagi, E., Canonica, G. W., Angino, A., Baldacci, S., Borbotti, M., Cerrai, S., Di Pede, F., Maio, S., Mangione, M., Martini, F., Pala, A. P., Piegaia, B., Sarno, G., Silvi, P., Viegi, G., Dente, F., Bacci, E., Paggiaro, P., Bancalari, L., Foschino, M. P., Moscato, G., Pilucchi, A., Bresciani, M., Pierimarchi, P., Brunetto, B., Iacovacci, P., Pini, C., Tinghino, R., Forestiere, F., Perucci, C. A., Porta, D., Ancona, L., Protasi, S., Lazazzera, B., Ziroli, V., D Armini, E., Campanile, S. F., Ferri, M., Lorusso, P., Pistelli, R., Salotti, R., Santagati, M., Agea, E., Casciari, C., Nicola MURGIA, Spinozzi, F., Bonifazi, A. F., Antonicelli, L., Braschi, M. C., Conti, V., Filippelli, A., Corbi, G. M., Russomanno, G., Baiardini, I., Balbi, F., Ferraioli, G., Bordo, A., Cerveri, I., Corsico, A., and Grosso, A.

Subjects
diagnostic procedures, cost, spirometry, continuing medical education, guidelines, Asthma, continuing professional development, drugs, hospitalization, medico-economic assessment

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