Playing doctor: Online game improves blood pressure treatment

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Physicians in a randomized trial who engaged in an online educational game that tested their knowledge of treatment for hypertension scored higher than controls in a post-test analysis and achieved modestly better improvement on outcome measures.

B. Price Kerfoot, MD, EdM, of Veterans Affairs Boston Healthcare System, and colleagues recruited 111 primary care physicians from eight Veterans Affairs medical centers between 2010 and 2011 to participate in the trial. The study also included patients of these physicians if they had one or more visit with a blood pressure reading of more than 140/90 mm Hg.

Fifty-five physicians were randomized to a spaced-education group that learned via a competitive online game and 56 to a control group. Both groups received emails with questions about hypertension management that once answered, linked to them educational content. But the game group’s experience was interactive and the control group’s was one-time only. There were 32 separate questions and explanations.

The spaced-education approach used an adaptive system that would resend the question after 12 days if it was answered incorrectly and after 24 days if answered correctly. If answered correctly twice, it was retired. Physicians in the game group could see how many others had answered correctly, and how many questions were retired.

Physicians took a pre- and post-test at enrollment and at 52 weeks. The entire cohort of physicians competed the pretest and 95 percent of the game group and 93 percent of the control group finished the post-test. Pretest scores were similar—58 percent and 60 percent, respectively. But the game group fared better in post-testing, scoring 90 percent compared with the control group’s 78 percent.

Kerfoot and colleagues found that the median time to a blood pressure target of below 140/90 mm Hg was shorter in the game group, at 129 days vs. 134 days for the control group. They determined that each physician engaging in the game led to 2.3 additional patients reaching the blood pressure goal.

“This study is particularly noteworthy because it is the first to demonstrate that an online educational game among medical professionals can improve the health measures of their patients,” they wrote.

The modest improvement in blood pressure control underscores the challenges of improving patient outcomes, though. They added that a future study will focus on educating patients through games.

The results were published online May 20 in Circulation: Cardiovascular Quality and Outcomes.