A GP evidence-based peer training program: the EPIDAS-Pneumo study

Article type
Cornu C, Cohen J, Luciani J, Boissel J
Background: We present here the teaching methods used in an on-ongoing randomised trial aimed at evaluating the impact of a GP peer education program on vaccination for pneumonia prevention in elderly people. The primary endpoint is the number of patients hospitalised for pneumonia. Eighty French administrative districts (AD) were randomised to GP peer training or not (control group). Objectives: To describe the training methods used in this field trial, and the difficulties encountered.

Methods: The educational methods used were defined in close collaboration with GPs with expertise in continuing medical education (CME) who were involved in the project. For the purpose of this trial, the training had to: 1) be evidence-based; 2) be easy to transmit from one GP to another during the usual time of a CME session, i.e. about 2 hours; 3) favour uptake of knowledge by the trainees; 4) organised independently from the pharmaceutical industry or 'experts'. Available evidence vaccination for prevention of pneumonia was synthesised in a booklet, with the source articles, and a glossary for the specialised terms. Trainers received training during two-day interactive seminars, and they were also asked to suggest how to improve the educational package. The trainers were then expected to organised 2 to 10 two-hour training sessions in their areas, involving at least 30% of the GPs in their area.

Results: The two-hour training sessions involved a pre-test to open the discussion. The educational method was derived from problem-based learning methods: a case description was used to initiate discussion and group problem solving. Most pertinent questions were raised and answered by the group, and this was completed by the trainer who provided additional information on the epidemiology of pneumococcal-related diseases, and vaccine efficacy using a meta-analysis. A video tape of specialists supporting this information, and of lay people raising questions or concerns was also used. This facilitated discussion between trainees on how to implement scientific evidence in routine practice. Training sessions ended with an evaluation questionnaire.

Conclusions: GPs in the study committees defined the modalities of the training sessions, the content of the training package, and helped to train the trainers. The difficulties identified were that 1) most groups of GPs do not have access to meeting rooms, or secretarial assistance for organising training sessions independently from industrial support; 2) trainers were asked to organise the sessions without support from experts outside their area, which is an unusual situation for CME in France; this means that trainers were initially the group animator, and then, during the second phase of the session "the expert". The trainers identified this as a difficult situation to manage. The funds available to trainers for organising sessions was also quite limited. This study received financial support from Aventis Pasteur MSD