Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 26 (2) Volume 26, Issue 2, Spring 2006 J Contin Educ Health Prof 2006; 26(2): RESEARCH ARTICLE Organizational Change in Management of Hepatitis C: Evaluation of a CME Program Judith Garrard Veena Choudary Holly Groom Eric Dieperink Mark L. Willenbring Janet M. Durfee Samuel B. Ho A b s t r a c t Introduction: Effective treatment regimens exist for the hepatitis C virus (HCV); however, clinicians are often resistant to evaluation or treatment of patients with alcohol or substance abuse problems. We describe a continuing medical education (CME) program for clinicians in a nationwide health care system, with emphasis on current treatment practices, multispecialty collaboration, and organizational change. Methods: Quantitative measures were used to assess changes in knowledge and treatment confidence, and site-specific organizational changes were qualitatively evaluated. The CME program included a preassessment of current HCV knowledge and care; a 2-day preceptorship; and follow-up with coaching calls at 1, 3, and 6 months. Program attendees included 54 medical and mental health providers from 28 Veterans Affairs Medical Centers. Results: Knowledge following the CME program increased significantly. In 93% of the sites, there were organizational changes such as HCV support group-initiated group education, inservice training, improvement in patient notification or scheduling processes, hiring of new clinical staff, development of a business plans, and discussions about changes with administration. Of all sites, 15 (54%) changed existing antiviral treatment protocols, 18 (64%) established collaborative relationships, and almost half (13/28) established regular use of depression and alcohol use screening tools. Major barriers to change included lack of administrative support or resources (or both) and difficulty collaborating with mental health colleagues. Discussion: This multifaceted CME program with follow-up coaching calls significantly increased individual knowledge and confidence scores and resulted in improved clinic processes and structures. Organizational change was facilitated by the development of an action plan. The major change agent was a nurse; the primary deterrent was an administrator. Lessons for Practice CME can emphasize training in how to obtain scarce resources through organizational changes, in addition to educating about the condition and its management The principle of developing an action plan to help clinicians obtain resources through organizational change probably can be applied to offer conditions in which both disease prevalence and patient demand for health care are increasing Participation in a CME program by multispecialty teams—for example, mental health and gastroenterology, or nurse and physician—can facilitate an understanding of how to make organizational change to improve patient access to services In this CME, if organizational change had not occurred in a health care site within the 3 months after the program, it was not likely to be present 6 months afterward Key Words: organizational change, integrated care model, hepatitis C, multispecialty education, qualitative evaluation, continuing education, medical
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