Article Text

  1. T. K. Houston1,2,
  2. D. Slovensky1,2,
  3. K. Moye1,2,
  4. E. Pryor1,
  5. T. Terndrup1,
  6. N. Weissman1,2,
  7. C. I. Kiefe1,2
  1. 1Deep South Center on Effectiveness at the Birmingham VA Medical Center, Birmingham, AL
  2. 2University of Alabama at Birmingham, Birmingham, AL


Background In the aftermath of 9/11/2001, providers' bioterrorism knowledge is increasingly important. Traditional continuing education is costly and may not have long-term impact.

Methods We conducted a randomized trial of BioCases, a case-based, interactive Internet-delivered bioterrorism educational intervention. By facility, providers were cluster-randomized on-line to BioCases versus the CDC bioterrorism Web site. The BioCases intervention included veteran-centric cases and supportive tools. After reviewing the Web site, providers were asked to complete a series of two BioTests related to anthrax and smallpox. The BioTests were 10-item, case-based knowledge assessments with score assigned as percent correct. Follow-up BioTests were completed at 3 months. Differences in BioTests scores were first assessed using t-tests, then using linear regression adjusted for provider age, gender, years in practice, and provider type, and using generalized estimating equations to account for clustering of providers within facilities.

Results The study had 332 participants (155 BioCases, 177 CDC control) from 15 VAMCs. Of those, 58% (n = 191) completed the immediate BioTest; were MDs (56%), DOs (25%), and NP/PAs (19%), with 51% male, and had a median 17 years in practice. Characteristics did not differ in test-takers versus non-test-takers or BioCases versus control. The most popular BioCases were anthrax (54% accessed), smallpox (51%), plague (42%), and viral hemorrhagic fever (39%). At post-test, the mean anthrax BioTest score of BioCases providers (50% [95% CI 46-53]) was higher than controls (40% [95% CI 36-44] p < .001). After adjustment, BioCases provider scores were again 9% higher (95% CI 4-12). However, scores on the smallpox BioTest were similar (52% BioCases vs 55% control, p = .2). Eighty providers completed 3-month follow-up, and differences in anthrax knowledge were sustained (53% BioCases vs 41% control), and no significant difference was seen for smallpox.

Conclusions We noted higher anthrax, but not smallpox, provider knowledge on immediate and delayed post-tests compared with the CDC control. Internet-delivered case-format education may have advantages over informational Web sites for increasing knowledge retention.

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