Standardized patient-based simulation training as a tool to improve the management of chronic disease

INTRODUCTION: Patient education is a critical factor in the treatment of chronic disease because it reduces gaps in health care and disease management. We implemented different methods of physician training for patient education of asthma and compared the effects on patients' health. METHOD: Four interventions were administered to groups of primary care physicians in one health care maintenance organization. All physicians received a list of their patients who were classified with uncontrolled asthma. Additional educational methods were implemented as follows: no additional intervention (group 1); lectures on patient education (group 2); standardized patient-based simulation training (group 3); and lectures and standardized patient-based simulations (group 4). We compared among the intervention groups and to a control group changes in rates of patients with uncontrolled asthma at 1 and 2 years after the intervention. RESULTS: During 1 year of follow-up, rates of uncontrolled asthma decreased from 7.2% to 6.2% (by 15%), from 7.5% to 6.5% (by 13%), from 6.4% to 5.1% (by 19%), and from 6.3% to 4.6% (by 27%) in intervention groups 1 to 4, respectively (P < 0.01). Rates decreased by approximately 7% more in all intervention groups at 2 years of follow-up. No decrease in rates was observed in the control group. CONCLUSIONS: An intervention for primary care physicians on educating patients with asthma to manage their disease resulted in improved patient health. The most effective intervention was the combination of lectures and standardized patient-based simulation.