Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial

Bousquet, Jean; Lund, VJ; Cauwenberge, Paul Van; Bremard-Oury, Clothilde; Mounedji, Nadjat; Stevens, MT; El-Akkad, Tarek

doi:10.1034/j.1398-9995.2003.00076.x

Cited by 153 publications

(140 citation statements)

References 39 publications

(38 reference statements)

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“…Physicians should therefore be wary of these limitations and always integrate recommendations in guidelines with their own clinical judgment, after careful clinical evaluation and assessment of patient and disease factors (15). Even with its limitations, following guidelines has proven to be advantageous in the treatment of allergic rhinitis (16) and asthma (17), strengthening the rationale of implementing them.…”

Section: Evidence-based Medicine and Guidelinesmentioning

confidence: 99%

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Spronsen

Ingels

Jansen

et al. 2008

Allergy

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Nasal congestion is an important symptom in nasal pathology and can be defined as an objective restriction of nasal cavity airflow because of mucosal pathology and/or increased mucus secretion (excluding anatomical variants). Using the new Grading Recommendations Assessment, Development and Evaluation system, evidence‐based recommendations are made that will encompass different clinical questions regarding diagnostic modalities of nasal congestion: (i) their usefulness in assessment of presence and severity of congestion; (ii) their usefulness in assessment of etiological pathology responsible for congestion; and (iii) their usefulness in follow up and treatment effectiveness evaluation of nasal congestion.

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Section: Evidence-based Medicine and Guidelinesmentioning

confidence: 99%

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Spronsen

Ingels

Jansen

et al. 2008

Allergy

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“…Moreover, an unknown proportion of intermittent and persistent AR patients treat themselves with OTC medications. Management of AR by PCPs can be improved in clinical trials by adoption of the structured approach inherent in guidelines, 18 but studies are needed to assess the long-term outcome and feasibility of these interventions in everyday clinical practice.…”

Section: Recommendationsmentioning

confidence: 99%

“…www.thepcrj.org 18. Please rank the following factors in order of importance to you, where 1 is the most important to you and 8 is the least important to you Improving patients' overall quality of life Preventing the onset or development of comorbidities of allergic rhinitis (AR) e.g.…”

mentioning

confidence: 99%

The current burden of allergic rhinitis amongst primary care practitioners and its impact on patient management

Cauwenberge

Hoecke

Kardos

et al. 2008

Primary Care Respiratory Journal

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Aims: To investigate the burden of allergic rhinitis (AR) amongst primary care practitioners (PCPs), the impact of AR on PCPs' professional lives, and the effect on their management of AR patients of PCPs' personal experience of AR.Methods: An online questionnaire was completed by 1201 PCPs (50% AR sufferers) from eight countries.Results: 21% of PCPs reported very well controlled symptoms and 66% quite good control. Six hours work per week, on average, was missed by PCPs whose AR symptoms resulted in absence. AR symptoms affected concentration, stress level, mood, time spent with patients, physical contact with patients, and patient throughput. PCPs with AR reported a significantly higher proportion of AR patients in their practice and gave a significantly higher ranking to specific treatment requests and emotional well-being, and gave a significantly lower ranking to preventing comorbidity development and providing a treatment most likely to result in high patient compliance.Discussion: This is the first study demonstrating the impact of AR on PCPs showing association with lost productivity, absenteeism and reduction in professional performance. Personal experience of AR significantly influences PCPs' management of AR and may improve their AR diagnostic ability.

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“…A number of studies reported substantial improvement in quality both in inpatient [1,11,14,18,21,32,50,53,57,60,62,68,78] and outpatient settings [13,29,37,40,42,46]. Numerous studies, including six RCTs [4,7,38,51,63,71], failed to show any positive effects on quality associated with practice guidelines [5,10,20,25,26,36].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

“…Finally, three systematic reviews reported that clinical practice guidelines could improve the efficacy, efficiency, and cost-effectiveness of care; however, the size of effect was variable and generally small [6,27,47]. Studies found greater effect with explicit guidelines [6,13,21,23,50,55], defined as ''systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances'' [27], although practice guidelines improved both processes and outcomes of care, including cost [14,29,53,62], and the results were greater for performance compared with patient outcomes. Clinician involvement in all aspects of guideline development was vital [5,46,53,73].…”

Section: Do Practice Guidelines Improve Quality Of Care?mentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial

Cited by 153 publications

References 39 publications

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

The current burden of allergic rhinitis amongst primary care practitioners and its impact on patient management

The Use of Three Strategies to Improve Quality of Care at a National Level

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