Complex cases in primary care: report of a CME-certified series addressing patients with multiple comorbidities


  • Disclosures
    Dr Rosenberg discloses that he has received speaker fees from Allergan, Inc., Astellas Pharma US, Inc., Forest Laboratories, Inc., GlaxoSmithKline, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer, Inc. and Watson Pharmaceuticals, Inc.; he has received consulting fees from Allergan, Inc., Astellas Pharma US, Inc., Ferring Pharmaceuticals, Inc., GlaxoSmithKline, Horizon Pharma, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Shionogi Inc. and Watson Pharmaceuticals, Inc. None of the other authors has any financial relationships to disclose.

Correspondence to:

Matt T. Rosenberg

214 North West Avenue

Jackson, MI 49201, USA

Tel.: +517 414 7235

Fax: +517 784 9657




To assess whether participation in a series of continuing medical education-certified activities presenting complicated case scenarios resulted in evidence-based decision making for patients with chronic comorbid conditions.


A series of interactive live workshops and online case studies presented evidence-based, practical information addressing the care of patients with multiple chronic diseases to primary care physicians. Clinical case vignettes were used to assess workshop participant knowledge and competence. Results were compared with those of matched non-participant controls. Online participants were surveyed to evaluate immediate knowledge gains from the activity.


Overall, physician workshop participants were 27% more knowledgeable of evidence-based treatment decisions. Participants were more likely to refer a patient with rheumatoid arthritis to a rheumatologist (57% vs. 36%; p = 0.035) and showed better recognition of medications that can contribute to overactive bladder symptoms (36% vs. 18%; p = 0.043) compared with non-participant controls. Non-significant differences in favour of participants included evidence-based decisions regarding the management of osteoporosis, attention deficit hyperactivity disorder in adults and type 2 diabetes mellitus in adolescents. Online participants demonstrated significant knowledge gains (p < 0.001) on 17 of 18 assessment questions across all therapeutic areas.


Chronic comorbid conditions afflict a sizable minority of patients. However, specific recommendations and education surrounding patient management are often overlooked because of the inherent difficulty of treating this group. Highly interactive educational activities can improve participant knowledge and competency in treating these patients by providing an opportunity to interact with faculty experts, receive immediate feedback and practice new skills.


Interactive educational activities that discuss complicated case scenarios can improve participant application of evidence-based medicine for patients with multiple chronic comorbidities.