Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change

Abstract

Abstract Background: Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE initiatives can help address diagnostic and treatment gaps for patients with retinal diseases in the long-term. Methods: This case-control study analyzed pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners who participated in the modular, interactive CE initiative VISION RELIEF. An additional medical claims analysis by IQVIA provided data on practice change, evaluating use of VEG-A inhibitors among retina specialist and ophthalmologist learners (n=7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. Results: Learners from all disciplines significantly improved knowledge/competence scores on items relating to early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values=0.003 to 0.004). Compared with matched controls, learners’ incremental total injections for anti-VEGF agents utilized for retinal conditions increased more after the CE intervention (P<0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed than from non-learners (P<0.001). Conclusions: This modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among a nationwide sample of retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to a carefully matched control. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists as well as its impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.