USING FOLLOW-UP SUPPORT WITH GRAND ROUNDS CME IN COMMUNITY HOSPITALS

Purpose. To determine the proportion of regional primary care physicia ns who would attend grand rounds on preventive services and their inte rest in and use of free follow-up enabling and reinforcing assistance to implement changes in their practice routines. Method. From January to July 1992 grand rounds on early detection of cancer were offered by Dartmouth Medical School at 38 acute care community hospitals in New Hampshire and Vermont. The target audience of 679 family physicians an d general internists was identified through state medical society and hospital attending lists. The hour-long grand rounds program described preventive service guidelines and an office system that promoted thei r implementation. Follow up practice support with planning, office sta ff training, and materials were offered to augment the effects of the grand rounds. Attendance was determined by sign-in documents. In addit ion, all attendees were asked to complete a survey regarding practice and personal characteristics and interest in follow-up assistance. Sta tistical comparisons were made using chi-square and Fisher's exact tes ts. Results. In all, 261 family medicine physicians and general intern ists (38.4%) attended. Certain categories of physicians were more like ly to have attended: internists, those younger than 55 years, and phys icians on the staffs of hospitals located in small towns. Assistance w as requested by 70.1% of the attendees; many requested more than one t ype of assistance. Physicians from hospitals in smaller towns were mor e likely to show interest in followup assistance and use it when offer ed. Conclusion. Many of the grand rounds attendees were receptive to f ollow-up assistance that could improve the preventive services they pr ovided. Most hospitals offer grand rounds, and many organizations have interest in and resources for helping physicians provide high-quality care. Future research should establish the best linkage to the actual care provided in practices and explore the relevance of similar appro aches to clinical areas beyond prevention.