America's healthcare system has some of the world's most highly trained clinicians, armed with the latest diagnostic equipment, medications, and medical devices. But magnetic resonance imaging can't detect breast cancer in the woman from Appalachia with no access to the teaching hospital six hours away. The latest antiretroviral agents that could halt HIV progression in a 25-year-old man from Washington, D.C.'s southeast side won't help if he doesn't have the insurance to pay for them or understand of how to manage his disease.

Americans are facing a “perfect storm” on the healthcare front. Besides the rising costs of healthcare and the increasing numbers of uninsured, there are other disparities (e.g., race, socioeconomic status, cultural and language differences) that impede access to quality healthcare.

Awareness, Prevention, Outreach

Many CME providers offer grand rounds in their leading academic institutions or dinner symposia in large metropolitan areas. But what about physicians who practice in smaller, inner-city clinics and rural or local hospitals? As part of a gap analysis, determine the practice type and location of the clinicians your activities are designed to educate. Ask clinicians to identify barriers to optimal treatment specific to their practice type and patient population. Do patients skip appointments because they lack transportation? Do they have health insurance or income to pay for routine exams? Here are some potential mechanisms to address these barriers.

Provide appointment reminder cards for routine checkups and follow-up visits. Consider including bus/subway routes or senior-care bus information to offer patients low-cost transportation options for visits.

Partner with patient advocacy groups for a patient-centric approach to CME activities to collaborate with activity faculty and develop pamphlets for physicians to provide to patients. Patient advocacy and outreach organizations can supply information on how to complete insurance paperwork, negotiate payment plans, and understand patient rights. And they can provide assistance in completing applications for Medicaid or other government programs, and offer patients support with disease management.

Maximize Your Materials

Go beyond the traditional syllabus or slide book you provide to participants during live activities.

Consider including reminder posters in the back of activity syllabi that can be displayed in doctors' offices or hospitals. These posters can remind clinicians and patients alike about the importance of preventive medicine and of regular monitoring for patients with hypertension or diabetes. Patients may not understand that early disease detection and diligent chronic disease management can preclude costlier treatments and hospital stays later.

Include evidence-based strategies for promoting a healthy lifestyle as part of a comprehensive patient management toolkit for clinicians. Translate these materials into multiple languages for a diverse patient population.

Engage other members of the treatment/management team. Include disease management guides with CME activity materials for nurses, nurse practitioners, physician assistants, and pharmacists along with information about obtaining lower-cost medications.

Close the Gaps

With healthcare reform on the agenda in Washington, the CME industry has new opportunities to address healthcare disparities. We can use existing CME methodologies to educate clinicians about improving patient access to healthcare. Clinicians will in turn need to educate their patients and teach them how to be part of a multifaceted support system.

Ann C. Lichti, CCMEP, is the vice president of Health Care Education Strategy for Veritas Institute for Medical Education Inc. Reach her at

Allison Bagin is program manager for Veritas Institute for Medical Education Inc. Reach her at

The opinions expressed are those of the authors and do not constitute the views of Veritas Institute for Medical Education Inc.