Implementing the guidelines in Continuous Medical Education by the Audit méthod.

1. Implementing the guidelines in Continuous Medical Education by the Audit méthod. Josiane ALBOUY (Regional Work Inspection for the « Région Centre »),  Annie DESCAMPS, Guy DOUFFET, Eric DRAHI, Philippe NICOT (UNAFORMEC). • The educational goals : • Identifying the expectations, beliefs and representations from the patient with low back pain. • Identifying the expectations, beliefs and representations from the practitioners of patients with low back pain • Analysing pain in its bio-psycho-sociological aspects • Identifying a symptomatic low back pain • Appropriating the guidelines made by the ANAES on patients treated and their diseases diagnosed for acute and chronic low back pain • Using an analogical visual scale to assess the pain • Knowing when advice or care from a psychologist or psychiatrist is required • Talking about pain with their patients • Negotiating with the patients for the therapy procedures • Working in collaboration with the work physician on the ergonomics of the job and the psychological conditions from the work environment • Working in collaboration with the medical consultant and the social assistants to anticipate on a possible chronic ill health • Carrying out an audit on practice on the care of a patient with low back pain. • Planning of the formation: • This formation consisting in 2 days (a formation of 14 hours) took place • according to the following sequences: • Module 1 The patient’s itinerary in the health system • Module 2 The guidelines • Module 3 Tackling the question of work and pain with the “worker-patient” • Module 4 The guidelines to help the patient with low back pain • Module 5 The list of occupational diseases and damages’ compensation • Module 6 Carrying out an audit of one’s own practice • Distinctive features of the creation of the evaluation: During a plenary assembly, at the end of each module, the following question was asked to the participants: • What did you learn during this sequence, which you did not do before, and you wish you would put into practice after the seminar? • The answers were written on a flip chart and kept until the end of the formation. • At the end of the formation a short sequence presents the methodology of the audit • Taking up the key points identified by the participants again • Five key points are selected by the participants thanks to the balanced choice after debating • The key factors are reworded as criteria and then questions • Confirmation of the referential guide by the participants and the experts thanks to the guidelines • Creation of the audit guide • A first round of audits took place fifteen days after the formation. The • second one three months later. In both cases, it concerned a prospective- • retrospective audit: data collection from the patient’s file and written • before the index consultation. • Selection criteria were reminded to the • participants when the audit guide was • sent to them • “In practice, you will have to analyse the five first files of patients with • low back pain in their work environmentaged 16 to 65 included • seen during a consultation in the consultation room  in sick leave • or not  with a common low back pain not a chronic one (excluding • patients with a symptomatic low back pain from less than three • months)  excluding pregnant women • Background • The implementation of • guidelines is a cause of • concern in all developed countries. • In France particularly, • guidelines seem to • have a limited effect on the • practice. Among the most efficient • methods to implement • guidelines, we find the • medical audit and the interactive • continuous medical formation • (FMC). • The UnaformeC, pioneer in the • interactive continuous medical • education, uses the practice’s • audit as a tool to reinforce the • educational benefits. If this • association is not original in itself, • yet the development of the criteria • for the audit by the participants • themselves during the training • and resulting from a • guideline is an original • method for the implementation • Objectives • Facilitate the implementation of a guideline thanks to interactive education. • Bring the learners during the formation into developing a guideline which will be used for the audit after the training and from a distance. • Check the possibility to make two rounds of audit with a guideline developed by participants during a formation. • Assess the improvements in the practice after the two steps of audit. • Method • and means • Continuous Medical Education • (FMC) on the topic of the risk of • low back pain in work environment • to become chronic. • Data sources: • ANAES : Management of diagnosis • and treatment for patients with low • back pain and low back sciatica • developed for less than three • months; February 2000. • ANAES : Diagnosis, treatment and • care for the patients with chronic • cases of the low back pain • ;December 2000. • Experts • A rheumatologist manager of a • functional therapy centre, a work • physician, a general practitioner • specialized in methodology. • Résults : • This formation shows how feasible the method is. • Out of 21 participants, 8 General Practitioners completed the first step and 17 the second one. • All the General Practitioners who participated the first step went through the second one.. • The number of questions given in the audit guides increased between the first and second rounds of audits. • The number of answers which conform to the guideline created by the participants increased in the second collection. • A third round is planned after 6 months to ensure with time that practices are improved.. With the audit guideline, we sent the participants the « Valat Score » which makes it possible to assess the probability for low back pain to become a chronic disease. We added instructions to use it for all patients with low back pain included in the protocol. DISCUSSION: The audit is a useful method during the formations in order to assess the participants’ acquired knowledge It concerns self-measuring methods, for which only anonymous general results are given to the participants. One of the major problems lies in the pertinence of the questions in the audit. We may improve the situation by working with criteria defined by the participants themselves, within the framework of a process for constant quality improvement. When the criteria are created from a guideline on clinical practice, used as an explicit documentary source, it is a real way to implement the guideline. Conclusion: This method can be put into practice. One to two criteria may be defined during sequences of three hours formations.. SFDRMG - UnaformeC Union Nationale des Associations de Formation Médicale Continue 261 rue de Paris 93556 MONTREUIL CEDEX FRANCE Courriel: unaformec@wanadoo.fr Toile: http://www.unaformec.org