Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial
| Autor: | Pentti Huovinen, Hannu Sarkkinen, Marjukka Mäkelä, Solja Nyberg, Helena Varonen, Timo Klaukka, Risto O. Roine, Ulla-Maija Rautakorpi, Pekka O. Honkanen, Erkki Palva |
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| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Population Guidelines as Topic Primary care Acute maxillary sinusitis State Medicine law.invention Academic detailing Anti-Infective Agents Randomized controlled trial law Humans Medicine Internal validity Practice Patterns Physicians' Intensive care medicine education Finland education.field_of_study business.industry Viral sinusitis Drug Resistance Microbial Maxillary Sinusitis Family medicine Acute Disease General practice Family Practice business |
| Zdroj: | University of Copenhagen |
| ISSN: | 1460-2229 0263-2136 |
| Popis: | BACKGROUND Management of acute maxillary sinusitis (AMS) is not optimal; antibiotics are often prescribed for viral sinusitis, which leads to many problems including those with antimicrobial resistance. Guidelines have been proposed as a means to change the professional practices. OBJECTIVE Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care. METHODS A multi-centre randomized controlled trial was conducted in 30 health centres (HCs) covering a population of 819 777 people from 1998 to 2002. The participating HCs were randomized to implement guidelines either according to a problem-based learning (PBL) or an academic detailing (AD) method facilitated by local GPs. Data were gathered during 1 week in November in all study years and also from external control HCs in 2002. The main outcome measure was compliance with the key points of AMS management in national Current Care guidelines. RESULTS Implementation of guidelines produced minor changes towards the recommended practices in the management of AMS. Use of the first-line drug amoxicillin increased slightly (from 39% to 48% in AD centres and from 33% to 45% in PBL centres, controls 40%). Proportion of courses of antibiotics with recommended duration increased in MIKSTRA study centres (from 34% to 40% in AD centres and from 32% to 47% in PBL centres, controls 43%). CONCLUSIONS A nationwide guidelines implementation project produced modest changes in the management of AMS. There were no significant differences between AD and PBL education methods. Less than half the HCs were able to realize the project as intended, which decreases the internal validity of the study. The guidelines implementation might have benefited of more focussed targets and approaches that took into account the problems and practices of each HC. |
| Databáze: | OpenAIRE |
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