Abstract: SA-PO180
Hyperkalemia in CKD: Can Virtual Patient Simulation Improve Management?
Session Information
- Educational Research
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 800 Educational Research
Authors
- Larkin, Amy, Medscape Education, Nicholasville, Kentucky, United States
- Gitzinger, Susan, Medscape, Medford, New Jersey, United States
- Blatherwick, Donald, Medscape, Medford, New Jersey, United States
- Warters, Martin, Medscape, Medford, New Jersey, United States
- Littman, Gwen S., WedMD, Durham, North Carolina, United States
Background
We sought to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of nephrologists and primary care physicians (PCPs) in the evidence-based management of chronic kidney disease (CKD)-associated hyperkalemia.
Methods
The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments mirroring the scope and depth of actual practice. Eevidence-based clinical guidance (CG) was provided following each decision, followed by the opportunity to modify their clinical decisions. Each user’s baseline (pre-CG) decisions were compared to their post-CG decisions using a 2-tailed paired t-test to determine P values. The CME launched online February 13, 2018, and data were collected through May 7, 2018.
Results
Case 1 (n=51 Nephrologists; n=367 PCPs):
Diagnose hyperkalemia: 16% improvement among nephrologists (51% pre-CG vs 67% post-CG; P=.051), 51% improvement among PCPs (50% pre-CG vs 71% post-CG; P<.001)
Continue/modify spironolactone therapy: 12% improvement among nephrologists (14% pre-CG vs 26% post-CG; P=.085), 15% improvement among PCPs (11% pre-CG vs 26% post-CG; P<.001)
Order follow-up potassium test: 12% improvement among nephrologists (59% pre-CG vs 71% post-CG; P=.105), 17% improvement among PCPs (50% pre-CG vs 67% post-CG; P<.001)
Prescribe a potassium binder: 22% improvement among nephrologists (16% pre-CG vs 18% post-CG; P=.395), 0% improvement among PCPs (4% pre-CG vs 4% post-CG; P=.5)
Case 2 (n=34 Nephrologists; n=307 PCPs):
Diagnose CKD Stage 3b: 41% improvement among nephrologists (9% pre-CG vs 50% post-CG; P<.001), 26% improvement among PCPs (17% pre-CG vs 43% post-CG; P<.001)
Appropriately initiate hyperkalemia therapy: 47% improvement among nephrologists (18% pre-CG vs 67% post-CG; P<.001), 48% improvement among PCPs (7% pre-CG vs 54% post-CG; P<.001)
Appropriately discontinue spironolactone: 29% improvement among nephrologists (9% pre-CG vs 38% post-CG; P=.001), 24% improvement among PCPs (30% pre-CG vs 54% post-CG; P<.001)
Conclusion
VPS that immerses and engages physicians in an authentic and practical learning experience improved evidence-based clinical decisions of both nephrologists and PCPs related to hyperkalemia management.