Effectiveness of feedback for improving case management of malaria, diarrhoea and pneumonia – a randomized controlled trial at provincial hospitals in Lao PDR

Abstract

Summarybackground Standard Treatment Guidelines were introduced to all prescribers at provincial hospitals in Lao PDR and treatment indicators were developed within the National Drug Policy programme to monitor compliance.objectives To evaluate the effects of an educational intervention to improve treatment practices of malaria, diarrhoea and pneumonia.methods Randomized controlled trial with prescribers at 24 departments at eight provincial hospitals, matched into four pairs. The three departments of internal medicine, paediatrics and out-patients in each pair were randomized into intervention or control group. The 6-month intervention was conducted by members of the Drug and Therapeutics Committees, and comprised monthly audit sessions in the form of outcome feedback using indicator scores on recorded treatment of malaria, diarrhoea and pneumonia. We measured treatment indicator scores 6 months after the end of the intervention compared with baseline.results The aggregated mean scores for all diseases, and for malaria and diarrhoea, improved significantly. For pneumonia, improvement was seen in both the intervention and control groups. Record keeping was improved for all three diseases. For malaria, there were improvements in recording patients' history, and in frequency of microscope testing; for diarrhoea, regarding weight measurements, palpation of the fontanel for children under 2 years, and reduction of irrational use of anti-diarrhoeals and antibiotics; for pneumonia, in recording respiratory count, and reducing irrational use of anti-histamines and anti-cough medications.conclusions Audit-feedback systems to improve quality of care are feasible and effective also in hospital settings in low-income countries.

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

“…The professional barriers may be reduced by extending the intervention with ready-to-use improvement tools [16, 33]. The few A&F studies that incorporated such support did so in different ways: through facilitated group discussions to reflect upon the feedback and identify improvement strategies [37] and by including suggestions in the feedback reports for how to address deficiencies in practice [38]. As the surplus value of adding supportive improvement tools to A&F interventions has not yet been investigated, we suggest that this be a focus of future research.…”

Meta-Analysis

“…As a form of “knowledge of results(2, 3)”, it is thought to improve performance by offering providers current performance information and motivation to improve; A&F has been used to improve a wide range of behaviors in clinical practice across many different settings (4), (5), (6), making it a highly flexible intervention. Though in the past A&F may have been laborious, requiring manual abstraction of paper charts, the increase in providers with access to electronic medical records(7) makes A&F a more feasible proposition.…”

An audit of inpatient management of community-acquired pneumonia in Oman: A comparison with regional clinical guidelines

“…Education-and audit-based interventions used before the implementation of guidelines showed a significant increase in the prescription of the appropriate antibiotics after the introduction of a ''multifaceted education program'' [1,21]. Auditfeedback systems to improve the quality of care have also been shown to be feasible and effective in hospital settings in low-income countries [28].…”