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      What difference does training make? A randomized trial with waiting-list control of general practitioners seeking advanced training in drug misuse : Impact of GP drug misuse training on care of opiate misusers: a randomized trial

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      Addiction
      Wiley

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          Abstract

          To measure changes in knowledge, attitudes and clinical practice of general practitioners (GPs) enrolled to receive training in the management of drug misusers. Two-group randomized trial with training (T) and waiting-list (WL) control comparison conditions. A total of 112 GPs working in primary care practices in England. A 6-month, part-time, mixed-methods training course provided by the Royal College of General Practitioners. GPs randomized to the WL control received no special training or guidance during the study period. Knowledge, therapeutic attitudes (commitment, role security, situational constraints and prescribing confidence) and clinical practice behaviour change (numbers of drug misusers seen, treated). Intention-to-treat/train (ITT) analysis, supplemented by treatment/training received (TR) analysis. Training applicants had positive attitudes towards and were already involved in the care of drug misusers. Improvements in attitudes and behaviour were greatest among the T group, although only 'role security' and 'situational constraint' reached statistical significance (ITT). A subgroup in the WL group circumvented their allocation and received training, prompting supplementary analysis by TR. Overall, GPs who received training showed markedly greater improvements in knowledge, attitudinal and prescribing confidence measures and remained more actively involved in treating drug misusers than GPs who remained in the WL control group (TR analysis). GPs seeking special training for the care of drug misusers are both positively disposed to this patient population and clinically active. Benefits unambiguously attributable to the course were modest. While a TR effect was observed, strict adherence to ITT analysis failed to identify significant benefits observed with the training provided. Randomisation and waiting-list controls design are insufficient as a research method for training evaluation studies if ITT analysis is used exclusively.

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          Evaluating and researching the effectiveness of educational interventions.

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            Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial.

            To assess the effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy. Parallel group, cluster randomised, controlled trial of an educational package on cognitive behaviour therapy. General practices in north London. 84 general practitioner principals and 272 patients attending their practices who scored above the threshold for psychological distress on the hospital anxiety and depression scale. A training package of four half days on brief cognitive behaviour therapy. Scores on the depression attitude questionnaire (general practitioners) and the Beck depression inventory (patients). Doctors' knowledge of depression and attitudes towards its treatment showed no major difference between intervention and control groups after 6 months. The training had no discernible impact on patients' outcomes. General practitioners may require more training and support than a basic educational package on brief cognitive behaviour therapy to acquire skills to help patients with depression.
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              Evaluation of the effectiveness of an educational intervention for general practitioners in adolescent health care: randomised controlled trial Commentary: Applying the BMJ's guidelines on educational interventions

              L A Sanci (2000)
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                Author and article information

                Journal
                Addiction
                Wiley
                09652140
                13600443
                October 2007
                October 2007
                : 102
                : 10
                : 1637-1647
                Article
                10.1111/j.1360-0443.2007.01929.x
                17662105
                d16c95a9-1ecb-4738-97b1-b3a4ebb49115
                © 2007

                http://doi.wiley.com/10.1002/tdm_license_1.1

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