National Meeting 2007

3040 — Participation of VA Physicians and Non-Physician Primary Care Providers in an Internet Delivered Educational Intervention: The MI Plus Study

Houston TK (Birmingham REAP) , Funkhouser E (Birmingham REAP), Tipton EF (Birmingham REAP), Levine DA (Birmingham REAP), Estrada C (Birmingham REAP), Kiefe CI (Birmingham REAP)

MI Plus is a randomized, controlled trial of an Internet-delivered intervention to improve treatment of ambulatory post–myocardial infarction (MI) patients with multiple co-morbidities. We recruited VA providers from Community Based Outpatient Clinics (CBOCs) across the nation. This report compares Physicians (MD) with non-Physicians (non-MDs), and among the latter, Physician Assistants (PA) with Nurse Practictioners (NP), regarding rates of enrollment and intensity of participation.

We recruited CBOC providers by phone and fax using no incentives other than CME. The intervention group is receiving a 30-month Internet-based educational program consisting of: 1) quarterly interactive cases on management of complex post-MI patients, 2) literature updates and 3) a “toolbox” with practice guidelines, treatment algorithms, and patient educational materials. We analyzed provider usage information and intensity of participation obtained electronically from the website.

Out of a pool of 699 VA MDs, 81 PAs, and 187 NPs, a higher proportion of non-MDs than MDs enrolled (50.4% vs 34.3%, p<0.001). This difference was present in all sizes of CBOCs, but not in all geographic regions. There was no overall difference between PAs (46.9%) and NPs (51.9%) in enrollment (p=0.5), though in small CBOCs, a higher proportion of NPs than PAs (64.9% vs 33.3%, p=0.03) enrolled. Among providers in the intervention group (125 MDs and 68 non-MDs), there were no significant differences between MDs and non-MDs in any measure of intensity of participation, namely, number of website visits, case modules completed, or months between first and last visit. Among intervention arm non-MDs (19 PAs and 49 NPs), 36.8% of PAs vs. 14.3% of NPs (p=0.05) completed 7 of the 8 cases, or were active for over a month (94.7% vs 55.1%, p=0.002).

Non-MDs had higher enrollment in an internet-based educational intervention than MDs, though the two groups were similar in the intensity in which they used the website; PAs seemed to participate more than NPs.

Internet-based educational interventions appear very attractive to CBOC non-MD providers, with half of those invited enrolling, and may succeed in enhancing their engagement in evidence-based care.