5 results
Knowledge of The Recognition and Management of Tardive Dyskinesia Markedly Improved Among Psychiatrists: Assessing the Impact of Online Medical Education
- Thomas Finnegan, Anjali Mehra, Jovana Lubarda, Chirag Shah, Andrew J. Cutler
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- Journal:
- CNS Spectrums / Volume 26 / Issue 2 / April 2021
- Published online by Cambridge University Press:
- 10 May 2021, pp. 153-154
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Introduction
Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotic medications that jeopardizes adherence to treatment and reduces quality of life. The recognition and management of TD can be challenging in many instances. An online activity was developed to assess the ability of continuing medical education (CME) to improve awareness of the recognition and management of TD among psychiatrists.
MethodsThe online CME activity consisted of a 30-minute video discussion between three expert faculty. Educational effect was assessed by comparing a matched sample of psychiatrists’ responses to four identical questions pre- and post-activity. A chi-square test identified significant differences between pre- and post-assessment responses. Cramer’s V was used to calculate the effect size of the online education (≥ 0.16 is considerable). Data were collected between June 26 and August 6, 2019.
ResultsActivity participation resulted in a considerable educational effect among psychiatrists (n=739; V=0.25, P<0.001). The following areas showed significant (P <0.05) pre- vs post-educational improvements: recognition of incidence of TD associated with different antipsychotic therapies, differentiation of TD from parkinsonism, and the personalized selection of therapies for the management of TD. 37% of psychiatrists had a measurable increase in confidence in understanding the role of the interprofessional team in recognizing TD after activity participation.
ConclusionsThe results indicated that a CME-certified 30-minute video activity was effective at improving knowledge among psychiatrists for the recognition and management of TD. Future education should continue to address best practices in the care of patients with TD.
FundingNeurocrine Bioscience, Inc
84 Assessment of Current Clinical Practices in Recognizing and Treating Bipolar Disorder
- Christoph U. Correll, Piyali Chatterjee, Susan H. Gitzinger, Jovana Lubarda, Marcello Morgan
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- Journal:
- CNS Spectrums / Volume 24 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 12 March 2019, pp. 217-218
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Background
Among adults in the US, bipolar disorder affects 2.6% or 5.7 million individuals; 83% of cases are considered to be severe. Even when an accurate diagnosis of bipolar disorder is established, its treatment remains suboptimal, and those with the disorder often fail to receive any care or evidence‐based care.
IntroductionA continuing medical education (CME)-certified 25-item, multiple choice clinical practice assessment survey was developed to assess recognition and treatment of bipolar disorder, specifically, the use of LAIs in these patients.
MethodsThe survey included knowledge- and case-based multiple-choice questions completed confidentially online. The survey was launched on December 20, 2017 and hosted on the Medscape Education website. Participant responses were collected through January 31, 2018. Confidentiality was maintained, and responses were de-identified and aggregated before analyses.
Results(n=1123 psychiatrists; 305 primary care physicians [PCPs]):
- When asked about assessment tools in bipolar disorder, only 43% of psychiatrists and 36% of PCPs could identify the correct use of the MDQ screening instrument, while only 64% of psychiatrists and 51% of PCPs knew that the use of the MDQ can improve recognition of bipolar disorder in patients with depression;
- Psychiatrists were more likely to correctly identify the symptoms that most strongly support a diagnosis of bipolar disorder compared to PCPs (76% vs 43%, respectively);
- When asked about laboratory testing in mood disorders, 52% of psychiatrists and 46% of PCPs knew that laboratory testing can help exclude alternative causes for mood symptoms;
- The majority of both healthcare professionals (73%–75%) did not know that diagnosis of bipolar I disorder relies heavily on changes in activity, energy, and mood;
- 87% of psychiatrists and 76% of PCPs did not identify oral aripiprazole as the only SGA not approved by the FDA for the maintenance treatment of bipolar I disorder;
- 49% of PCPs did not recognize lithium as the first choice for maintenance monotherapy for bipolar I disorder according to the guidelines;
- Only 19% of psychiatrists and 20% of PCPs correctly chose aripiprazole monohydrate and risperidone microspheres as the LAI SGAs indicated for use as monotherapy for patients with bipolar I disorder;
- When asked what is the most common barrier to prescribing LAI antipsychotics in patients with bipolar disorder, 34% of psychiatrists selected “Patients fear of injectables”
ConclusionsThis educational research identified psychiatrists and PCPs’ current real-world clinical practices and gaps in the knowledge and competence in the diagnosis and assessment of bipolar disorder, and the treatment options for this condition. Further educational efforts tailored to address identified gaps for each audience are warranted.
Funding Acknowledgements:Otsuka
28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation
- Jovana Lubarda, Martin Warters, Piyali Chatterjee, Marlene P. Freeman, Roger S. McIntyre
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- Journal:
- CNS Spectrums / Volume 24 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 12 March 2019, pp. 189-190
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Objectives
The goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).
Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps
∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records
∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions
∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant
∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.
Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:
∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)
∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)
∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)
∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CG
ConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.
Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.
145 Improving Management of Mood Disorders Through an Online Interactive Patient Case Challenge
- Jovana Lubarda, Piyali Chatterjee-Shin, Joseph F. Goldberg
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- Journal:
- CNS Spectrums / Volume 23 / Issue 1 / February 2018
- Published online by Cambridge University Press:
- 15 June 2018, pp. 90-91
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Background
To determine if online continuing medical education (CME) could improve knowledge, competence, and confidence of psychiatrists and primary care physicians (PCPs) in managing patients with major depressive disorder (MDD) and co-occurring hypomanic/manic features.
Methods∙ Physicians participated in a 1-hour text-based, online CME activity composed of 2 patient cases with interactive questions related to diagnosis, assessment, and management of various presentations of MDD
∙ Evidence-based educational feedback was provided following each answer
∙ Effects of CME were assessed using a repeated-question pairs pre- to post-assessment study design where individual participants served as his/her own control
∙ The assessment included 3 multiple-choice knowledge/competence questions and 1 self-efficacy question that rated confidence in managing MDD with mixed features on a 5-point Likert Scale
∙ For all questions combined, McNemar’s chi-square test assessed the differences from pre- to post-assessment
∙ P values measured significance; P values <.05 were considered statistically significant
∙ Effect size was calculated using Cramer’s V by determining the change in proportion of participants who answered questions correctly from pre- to post- assessment
∙ Survey data were collected from December 8th, 2016, to January 24th, 2017.
Results∙ Data set included responses from 1454 psychiatrists and 488 PCPs who completed all assessment questions during the study period
∙ Psychiatrists: Knowledge/competence improved (P<.001; V=0.54; large educational effect) following participation in the CME activity:
° While 5% answered all 3 questions correctly on pre-assessment, 70% answered them all correctly on post- assessment, with the largest increases on accurate differentiation between possible signs of mania and depression, accurate diagnosis of bipolar depression, and ability to select treatments for MDD with mixed features
° 20% reported being more confident in their ability to select treatments for various presentations of mood disorders
∙ PCPs: Knowledge/competence improved (P<.001; V=0.49; large educational effect) following participation in the CME activity:
° While 2% answered all 3 questions correctly on pre-assessment, 48% answered them all correctly on post-assessment, with the largest increases on accurate differentiation between possible signs of mania and depression, accurate diagnosis of bipolar depression, and ability to select treatments for MDD with mixed features
° 24% reported being more confident in their ability to select treatments for various presentations of mood disorders
ConclusionsOnline CME in a clinically relevant interactive case-based format can improve knowledge, competence, and confidence in management of various presentations of mooddisorders and better equip physicians to recognize key features, accurately diagnose, and treat the complex spectrum of this patient population.
Funding AcknowledgementsThe educational activity and outcomes measurement were funded through an independent educational grant from Sunovion Pharmaceuticals Inc.
144 A Clinical Practice Assessment In Tardive Dyskinesia: Are Physicians Up-to-Date?
- Jovana Lubarda, Stacey Hughes, Christoph U. Correll
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- Journal:
- CNS Spectrums / Volume 23 / Issue 1 / February 2018
- Published online by Cambridge University Press:
- 15 June 2018, pp. 89-90
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Study Objectives
To assess physicians’ current knowledge, skills, competence, and practice barriers regarding tardive dyskinesia (TD) and assess continuing medical education (CME) needs.
Assessment MethodsA 29-question clinical practice assessment survey instrument consisting of multiple-choice knowledge and case-based questions was administered online to gather abaseline “snapshot” of knowledge, skills, attitudes, and competence on TD epidemiology, risk factors, diagnosis, current guideline-based management, and emerging management strategies
The survey launched online on a website dedicated to continuous professional development on July 25, 2016, and was made available to healthcare providers without monetary compensation or charge. Data were collected through August 28, 2016
Confidentiality was maintained and responses were de-identified and aggregated prior to analyses
ResultsData were collected for the 1157 psychiatrists and 177 neurologists who responded to all survey questions during the study period. The findings were:
∙ Epidemiology: 62% of psychiatrists and 68% of neurologists were aware that TD affects approximately 20% of patients treated with neuroleptic agents
∙ Risk factors: 63% of psychiatrists and 67% of neurologists were aware of risk factors for TD, such as older age
∙ Diagnosis: 93% of psychiatrists and 71% of neurologists were aware that Abnormal Involuntary Movement Scale (AIMS) can be used to support diagnosis of TD
∙ Guidelines: 21% of psychiatrists and 11% of neurologists were aware of the American Psychiatric Association guidelines for monitoring of TD, and 56% of psychiatrists and 42% of neurologists were aware of the American Academy of Neurology guidelines on treatment of TD
New/emerging treatments: 24% of psychiatrists and 34% of neurologists were aware of the mechanisms of action of new/emerging treatments for TD, and 54% and 44%, respectively, were aware of the clinical data for valbenazine
ConclusionsThis educational research yielded important insights into clinical practice gaps in TD, indicating that both psychiatrists and neurologists would benefit from continuing medical education on epidemiology, risk factors, diagnosis, guideline-based care, and information on how to incorporate new/emerging treatments for TD into practice.
Funding AcknowledgementsThe educational activity and outcomes measurement were funded through an independent educational grant from Neurocrine Biosciences, Inc.