Primary care providers who engaged in an online game to solve clinical cases about hypertension management improved blood pressure control of their patients in a shorter amount of time compared to non-gamers, according to a new study by researchers at Brigham and Women's Hospital and the Veterans Affairs Boston Healthcare System.

Leveraging spaced education, a learning concept in which students may significantly increase knowledge retention if information is presented and reinforced over spaced intervals of time, researchers found that primary care clinicians who participated in an online spaced-education game improved their knowledge of managing high blood pressure and generated a modest but significant decrease in the time it took for their patients with high blood pressure to reach their blood pressure target.

A two-arm randomized trial was conducted during the course of a little more than a year among primary care clinicians at eight VA hospitals in the northeast U.S. Clinicians were randomized to either a group that received educational content about lowering blood pressure in the form of an online game versus a group who received identical content via a static online posting. One hundred and eleven clinicians enrolled in the study. Of those enrolled, 48 completed the trivia game while 47 completed the readings of the online posting.

Educational content consisted of 32 validated clinical cases followed by multiple-choice questions with explanations on hypertension management. Those in the online game group were emailed one question every three days. Questions were re-sent in 12 or 24 days if answered incorrectly or correctly, respectively. A question was retired when clinicians answered it correctly twice consecutively. The game would post clinician scores to foster competition.

Primary outcome measured was time to reach blood pressure target (less than 140/90 mm Hg). In multi-variable analysis of 17,866 hypertensive periods among 14,336 patients, the researchers observed a modest decrease in the time to achieve target blood pressure values in patients treated by clinicians in the online game group. Researchers found that patients of clinicians playing the game lowered their blood pressure to their target level in 142 days compared to 148 days for those whose clinicians read an online posting.

"This study is the first to show that an online educational game among medical professionals can improve the health measures of their patients," said co-lead author Alexander Turchin, M.D. ”Based on our findings, educational games may be effective tools to engage health professionals, boost learning, optimize practice patterns, and improve patient outcomes. We hope that future studies continue to focus on figuring out how to most effectively integrate games into the education of health professionals for the benefit of their patients."

According to the researchers, anyone can enroll in the spaced-education game for free at Qstream, a start-up company launched by Harvard University to develop and disseminate the spaced-education methodology outside of its firewalls.

The study, published in Circulation: Cardiovascular Quality and Outcomes, is available here.

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