Improving Care for Veterans: The Impact of VHA-Targeted CME

Veterans being treated in Veterans Health Administration (VHA) facilities represent a special patient population associated with a number of challenges. These patients have a higher rate of lung cancer due to increased smoking and exposure to carcinogens such as Agent Orange, and they also experience a higher rate of comorbidities and lower quality of life. Oncologists working within VHA facilities face a difficult task when providing care to veterans, and require thorough education and guidance to ensure these special patients receive the best possible care.

prIME Oncology recently hosted a series of 9 live continuing medical education (CME) meetings within VHA facilities, designed to increase familiarity with immunotherapy as a treatment for non-small cell lung cancer (NSCLC) and early identification and management of treatment-related side effects associated with these agents. Outcomes from this meeting series were recently presented.

The Results

Baseline testing revealed that physicians at VHA facilities had lower baseline knowledge and competence regarding the treatment of NSCLC than their counterparts non-VHA settings. Only 27% of questions were answered correctly by VHA clinicians compared to non-VHA clinicians. Participation in the meeting improved VHA clinicians’ knowledge regarding several key areas related to the treatment of NSCLC. VHA clinicians registered a 27.5% increase in their ability to assess the mechanism of action for immunotherapies, a 66.7% increase in their ability to select the most appropriate treatment for a patient based on patient and disease characteristics, a 132% increase in their ability to manage treatment-related side effects, and an impressive 180.95% increase in their ability to evaluate clinical trial data.

The improvement in knowledge through participation in the meeting series translated into an improved ability to manage patient care. At the start of the meeting, 45% of VHA clinicians indicated they were unsure regarding how to treat a patient with newly diagnosed, PD-L1-positive metastatic NSCLC, and only 30% correctly selected pembrolizumab monotherapy. However, following participation in the meeting, only 3% of VHA clinicians were unsure about treatment, and 54% accurately selected pembrolizumab. Likewise, participants were able to more accurately select treatments for patients with stage III NSCLC, with 60% correctly identifying the progression-free survival (PFS) benefit associated with durvalumb in this setting by the end of the meeting. Finally, 58% of clinicians who participated in this meeting series were able to suggest appropriate treatments for a patient with immune-related adverse events at its conclusion, an increase from only 25% prior to the meeting.

Implications for Future Education

Clinicians at VHA facilities have an increased need for education, both because of the complex patient population they treat and because of a lower level of knowledge regarding current and emerging therapies. However, as this analysis demonstrates, targeted CME can have a drastic impact on the ability of VHA clinicians to care for their patients with cancer. These results support the efficacy of live, local education in overcoming knowledge gaps among clinicians in the VHA and may serve as a model for future VHA-targeted CME.

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