Impact of interactive web-based education with mobile and email-based support of general practitioners on treatment and referral patterns of patients with atopic dermatitis: randomized controlled trial

BACKGROUND: The effects of various educational strategies have been examined in continuing medical education. Web-based learning has emerged as an alternative to ordinary classroom lessons. OBJECTIVE: To investigate whether an interactive Web-based course including personal guidance via email or cellular phone texting may be used to improve practice behavior of general practitioners in the management of atopic dermatitis. METHODS: General practitioners from all over Norway were eligible for this randomized controlled educational trial. During a period of 6 months, doctors in the intervention group were offered the opportunity to participate in a Web-based course on the management of atopic dermatitis. This was combined with guidance via email or multimedia messaging service (MMS) through mobile phones from a dermatologist. In the control group there was no education or guidance. Main outcome measures were the duration of topical steroid treatment prescribed to patients with atopic dermatitis (primary outcome), number of treatment modalities, and number of referred patients. RESULTS: We enrolled 46 physicians: 24 doctors were allocated to the intervention group and 22 doctors to the control group. They reported a total of 190 patient treatments. There were no statistically significant differences in the duration of topical steroid treatment or number of treatment modalities between the groups. The lack of effect on the primary outcome may be due to attrition as 54% (13/24) of the participants did not complete the course. 42% (10/24) of physicians sent at least one educational request via email or MMS. While 11% (8/73) of treatment reports in the intervention group were referred to a health care specialist (eg, dermatologist or pediatrician), 30% (21/71) of treatment reports in the control group did so. This difference in the number of referrals was significant (P = .03). CONCLUSIONS: A Web-based educational intervention aimed at general practitioners combined with personal support can reduce the number of atopic dermatitis patient referrals to specialists.