Mixed Methods Patient and Physician Research in Diabetic Eye Health Education World Congress on CPD: March 18, 2016 Supported by an educational grant from Genentech, Inc.
Faculty Richard Beaser, MD Chair, Professional Education Committee Joslin Diabetes Center Associate Clinical Professor of Medicine, Harvard Medical School John Scott, CHCP Senior Manager Educational Manager Medical Education & Research Grants, Genentech Robert Rosenbloom, MBA President and CEO PlatformQ Health Education Wendy Turell, DrPH, CHCP, FACEHP Senior Director, Outcomes and Analytics PlatformQ Health Education 2
Agenda 1 2 3 4 Alignment of Patient and Physician Education Overview of HCP and Patient Virtual Series Mixed Methods Outcomes to Date Implications 3
Alignment of Patient and Physician Education
What are we trying to accomplish? 1 2 To get more people with diabetes seen by ophthalmologists early in the progression of diabetes--and regularly thereafter To give ophthalmologists the opportunity to screen for the presence of early diabetic retinopathic changes and intervene with timely and affective treatments once they occur 5
What are we trying to accomplish? A tri-level approach to accomplish this goal Patients Empower patients to be their own advocates for optimal ophthalmologic care Primary Diabetes Care providers Encourage primary diabetes care providers to more effectively promote regular eye exams to their patients due to these providers' improved understanding of the process of diabetic eye disease and its treatments. Ophthalmologists Encourage the utilization of new treatments for diabetic eye disease when indicated 6
Learning Objective Alignment: An example Specialist Carefully assess patients to determine the most appropriate course of diabetic retinopathy therapy Develop treatment regimens using recommended pharmacologic and nonpharmacologic interventions Primary Diabetes Care Provider Apply guideline recommendations for timely and regular screening for DR risk factors, eye exams and prompt referral to retina specialist or ophthalmologist for diagnosis Patients After viewing this program, you will learn about: The importance of getting your eyes checked for diabetic retinopathy to prevent vision loss Treatments for diabetic retinopathy 7
Diabetic Retinopathy Instant Symposia and Patient Education Series* Broadcast Live-Online from Boston + On-Demand June 25, 2015 July 22, 2015 Game-Changing Therapeutic Advances in Diabetic Retinopathy CME Activity Diabetic Retinopathy: Role of the Primary Care Provider in the Optimal Care Model Strategies for Prevention and Risk Reduction CME Activity Specialists Primary Diabetes-care Primary providers Care July 29, 2015* Diabetic Retinopathy Part 1: What is It and Are You at Risk? Patient Education Patients October 7, 2015 October 14, 2015 Achieving Better Outcomes for Patients with Diabetic Retinopathy: The Expanding Role of the Ophthalmologist CME Activity Diabetic Retinopathy Part 2: Preserving Your Eye Sight Patient Education Specialists Patients *On-Demand Hosting, Outcomes Tracking and Event Marketing Through April 2016
IME Trends: Evolution of the Medical Education Industry over Time The Former IME Model Topics based on general interests, surveys Passive learning The Current Expected IME Model: Closing Healthcare Gaps Knowledge & Confidence Narrowly focused on knowledge One size fits all Change in Practice Patterns Quality Care Delivery Credit = Hours in seats Metrics = participation and satisfaction Patient Engagement 2015, Genentech / Proprietary information Please do not copy, distribute or use without prior written consent
Activate, or Understand the Gap Advance, or Address the Gap Aspire, or Practice the Solution Allocate, or Extend the Solution
Overview of HCP and Patient Virtual Series
DiabetesSeriesLive: A Site for HCPs DiabetesEyeHealth: A Site for Patients/Caregivers Live & On Demand Streaming Video HCPs: Lively Interaction between faculty presenters Real Time Q&A & Polling Connect from any Device Patients: Inclusion of patient presenters on discussion panel Video tour of eye clinic 12
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Mixed Methods Outcomes to Date
Online Event Engagement by Audience & Activity Live Participants On-Demand Participants* Total Participants* Avg. Duration Specialty Programs 249 521 770 40:53 Primary Care Program 152 291 443 43:51 Patient Programs 287 4,734 5,021 69%, 75% * Reflects data as of March 14, 2016
Specialty Programs Outcomes Feedback Did your participation in this educational activity have any positive impact on patient experience or outcome? Did your participation in this educational activity have any positive impact on your clinical practice? 34% Yes 32% 10% 56% No Not applicable 4% 64% 56% 64% Source: follow-up survey, n = 120 (Specialty Programs)
Primary Diabetes Care Program Outcomes Feedback Did your participation in this educational activity have any positive impact on patient experience or outcome? 7% 20% 73% Yes No Not applicable Did your participation in this educational activity have any positive impact on your clinical practice? 11% 2% 87% 73% 87% Source: follow-up survey, n = 56 (Primary Diabetes Care Providers Program)
Patient Programs Outcomes Feedback Did this program help you to improve the way you care for your diabetes? Did this program help you to improve the way you care for your eye health? 13% 6% Yes 4% 10% No 81% Does not apply to me 86% 81% 86% Source: Source: follow-up survey, n = 127 (patient programs)
Qualitative Results: Methods 21 In Depth Interviews conducted via telephone 11 interviews with Program 1 participants (Diabetics, no DR) 10 interviews with Program 2 participants (Diabetics, with DR) Recorded, transcribed, analyzed with qualitative software involving coding and theme identification (grounded theory methodology)
Patient Gaps Uncovered via Qualitative Interviews Knowledge Gaps remaining regarding clear definition of DR Few participants identified high blood pressure or cholesterol as risk factors. Self-Efficacy Although adherent with regular eye exams pre-education, many participants remain uncertain about the role of retinal exam in screening for and monitoring diabetic retinopathy post-education. Communication Poor communication with patients about disease prevention/progression reported as the norm. Participants did not view HCPs as established sources of verbal or written information about DR.
Implications
Professional Gaps Uncovered: Specialist programs Gap topics identified Summary of Responses from Specialists Pathophysiology of diabetic eye disease Knowledge about the interrelationship s among diabetes and its comorbid conditions, diabetes control, and eye pathophysiology Comparative risks and benefits of treatment options for diabetic retinopathy Alternative and emerging therapies for diabetic eye disease Details about anti-vegf treatment: How it is performed, duration, frequency Potential adverse effects Long term sequelae Indications for Ophthalmologist referral and anti-vegf treatment Impact of other conditions and treatments such as anticoagulation and diabetic eye disease Lasik surgery implications of anti-vegf therapy
Professional Gaps Uncovered: Primary Diabetes Provider Program Gap Topics Identified Summary of Responses from Primary Diabetes Care Providers Diabetic eye disease and diabetes control Correlation with overall glycemic control Impact of intensification of therapy Implications of weight loss Temporal onset of diabetic retinopathy following diagnosis of type 2 diabetes The spectrum of treatments for diabetic retinopathy: Description Indications Choosing one vs. another, or combinations Impact on restoring/preserving vision How to talk to patients about the treatments for diabetic eye diseases Management of other eye conditions in people with diabetes and diabetic eye disease Routine eye examinations: Recommendations for eye examinations by eye-care professionals Primary care role Telemedicine
Patient Gaps Uncovered: Quantitative Evaluation Gaps Topics Identified Summary of Responses from Patients Diabetic Eye Disease and Glucose control Impact of glucose and BP control on development/progression Specific impact of these conditions on the eye Getting eye care for people with diabetes Importance of yearly eye exams Understanding dilated exams: what they are and why they are important Treatments for diabetic retinopathy and macular edema Description of the treatments particularly laser and injections Differences and interrelationships between retinopathy and macular edema Injection therapy: its impact on neovascularization Impact/interrelationship of other eye conditions and diabetic eye disease Glaucoma Pregnancy Use of blood thinners Whether having family members with diabetes and vision problems can increase a person s risk of developing diabetic retinopathy
Implications for Multi-Constituent Education 1. Contrast of this approach with Performance-improvement CME 2. Are Care Hierarchies an important educational target? Specialist + Primary provider of care for the condition + Patient Primary provider of care for the condition + educator/support provider + patient Specialist + Primary provider of care for the condition + educator/support team Primary Provider of care for the condition + patient + administrative team member 3. If Care Hierarchies are important, should the focus of education (and possibly education support) be health plans? If so Can we actually develop coordinated education within a plan? Can we collect enough data to demonstrate that it is cost effective and improves patient outcomes
Q&A