Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study

doi:10.1136/bmj.325.7369.877

BMJ 2002;325:877-880 ( 19 October )

Learning in practice

Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study

Anna Kiessling, head of the centre for clinical education, ^a Peter Henriksson, professor of internal medicine. ^b

^a Centre for Clinical Education, Danderyd University Hospital and Karolinska Institute, SE-182 88 Stockholm, Sweden, ^b Department of Medicine, Karolinska Institute at Danderyd University Hospital, SE-182 88 Stockholm, Sweden

Correspondence to: P Henriksson Peter.Henriksson{at}med.ds.sll.se

Objective: To study the efficacy of case method learning,for general practitioners, on patients' lipid concentrations inthe secondary prevention of coronary arterydisease.
Design: Prospective controlledtrial.
Setting: Södertälje, Stockholm County,Sweden.
Participants: 255 consecutive patients with coronary arterydisease.
Intervention: Guidelines were mailed to all general practitioners(n=54) and presented at a common lecture. General practitionerswho were randomised to the intervention group participated inrecurrent case method learning dialogues at their primary healthcarecentres during a two year period. A locally well known cardiologistserved as afacilitator.
Main outcome measure: Concentration of low density lipoprotein cholesterolat baseline and after two years. Analysis according to intentionto treat (intervention and control groups (n=88)) was based ongroup affiliation atbaseline.
Results: Low density lipoprotein cholesterol was reducedby 0.5 mmol/l (95% confidence interval 0.2 to 0.8 mmol/l) (9.3%(2.9% to 15.8%)) from baseline in patients in the interventiongroup and by 0.5 (0.1 to 0.9) mmol/l compared with controls (P<0.05).No change occurred in the control group (0.0 ( $-$ 0.2 to 0.2) mmol/l).Low density lipoprotein cholesterol decreased by 0.6 (0.4 to 0.8)mmol/l in a group of patients who received specialistcare.
Conclusion: Case method learning resulted in a loweringof low density lipoprotein cholesterol in the primary care patientswith coronary artery disease comparable to that achieved at aspecialist clinic. Conventional presentation of practice guidelineshad noeffect.

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