Online CME Improves Diagnosis and Management of Hyperkalemia in CKD

Amy Larkin, PharmD, and Donald Blatherwick at Medscape, New York, New York, conducted an analysis to examine whether virtual patient simulation (VPS)-based continuing medical education (CME) would  improve the performance of nephrologists in diagnosing and managing patients with hyperkalemia. Results were reported during a poster session at the NKF 2022 Spring Clinical Meetings in a poster titled Effective Online Virtual Patient Simulation Can Improve Diagnosis and Management of CKD and Chronic Hyperkalemia by Nephrologists.

The intervention consisted of a patient presenting at two different time points in a VPS platform that allows learners to order laboratory tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice.

Following each decision, tailored clinical guidance (CG) based on current evidence and expert recommendations was provided. Learners were then provided an opportunity to modify their decisions. Following completion of the clinical guidance portion of the intervention, decisions were collected and compared with each user’s baseline decisions. P values were determined using a McNemar’s test. The activity was posted October 30, 2020; initial data were collected through March 10, 2021.

A total of 86 nephrologists completed the activity (all decisions within at least one case) and were included in the analysis of results. Following CG, there were significant improvements.

During the simulated initial visit, there were seven decisions of interest: (1) diagnose CKD stage 3b; (2) diagnose hyperkalemia; (3) initiate a potassium binder; (4) initiate loop diuretic; (5) discontinue oral naproxen; (6) order patient education; and (7) order nutritional counseling.

Improvements in the seven decisions following CG were: (1) 34% absolute improvement (8% pre-CG vs 42% post-CG; P<.01); (2) 29% absolute improvement (8% pre-CG vs 37% post-CG; P<.01); (3) 36% absolute improvement (22% pre-CG vs 58% post-CG; P<.01); (4) 57% absolute improvement (5% pre-CG vs 62% post-CG; P<.01); (5) 10% absolute improvement (85% pre-CG vs 95% post-CG; P<.01); (6) 12% absolute improvement (50% pre-CG vs 62% post-CG; P<.01; and (7) 15% absolute improvement (50% pre-CG vs 65% post-CG; P<.01), respectively.

During the simulated follow-up visit, there were five decisions of interest: (1) diagnose chronic hyperkalemia; (2) continue potassium binder; (3) continue loop diuretic; (4) order patient education; and (5) order nutritional counseling. Post-CG, improvements were: (1) 36% absolute improvement (4% pre-CG vs 40% post-CG; P<.01); (2) 9% absolute improvement (89% pre-CG vs 98% post-CG; P<.05); (3) 11% absolute improvement (87% pre-CG vs 98% post-CG; P<.05); (4) 13% absolute improvement (47% pre-CG vs 60% post-CG; P<.01; and (5) 17% absolute improvement (36% pre-CG vs 53% post-CG; P<.01), respectively.

The researchers said, “VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of hyperkalemia.”

Source: Larkin A, Blatherwick D. Effective online virtual patient simulation can improve diagnosis and management of CKD and chronic hyperkalemia by nephrologists. Abstract of a poster (poster 296) presented at the National Kidney Foundation 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022.