Primary care nurses using guidelines in Thailand: a randomized controlled trial

Abstract

Summarybackground Nurses run primary health centres in Thailand. We examined whether clinical guidelines improved the quality of the care they provide.methods Eighteen nurse-led health centres randomized to (a) guidelines, receiving a training workshop plus educational outreach visit, with guidelines for children (acute respiratory tract infection and diarrhoea) and adults (diazepam prescribing and diabetes management) or (b) usual care. Outcomes were changes at 6 months in antibiotic use, diazepam prescribing, drug costs per patient, and a composite process index for diabetes care.results Baseline prescribing was high for antibiotics (37% of all attendees), and no difference between intervention and control sites was detected at follow-up for this variable. In children (0-5 years old), antibiotics were widely used for acute respiratory tract infection (34%), and fell with guidelines (intervention: 42% at baseline to 27% at follow-up; control: 27-30%, P ¼ 0.022), with an associated fall in drug costs per patient. Antibiotics were widely prescribed for diarrhoea in children (91%), but no change was detected with guidelines. In adults, diazepam prescribing at baseline was high (17%), and fell in the guidelines group (intervention: 17-10%; control 21-18%; P ¼ 0.029). Diabetes care was generally good, and changed little with guidelines.

Evidence-based guideline implementation in low and middle income countries: lessons for mental health care

“…The ICD-10 training kit, an educational training programme and materials produced by the WHOImplementation strategies therefore comprised: educational meetings and educational materialsGP’s attitudes, knowledge, interview skills and ability for diagnosing psychiatric disorders in a primary care settingThere was statistically significant improvement in GP’s optimism about helping patients with mental disorders and in their confidence in their ability to diagnose mental disorders following the intervention. There was no statistically significant change in GP’s interest in patients with mental disorders or in their reporting of the importance of diagnosing mental disorders.Pagaiya and Garner [41]ThailandPhysical health (diabetes mellitus) and mental health (anxiety and panic disorder)Cluster randomised controlled trialModerate risk of bias CPG Four clinical guidelines introduced: two for children (acute respiratory infection and diarrhoea); two for adults (diazepam prescribing for anxiety and panic disorder and management of diabetes mellitus) Setting and participants Health centres in Khon Kaen province in Thailand, mainly in rural areas. 9 health centres were randomised to receive the intervention and 9 to control.…”

“…Four of these papers related to the introduction of CPGs for non-communicable diseases in physical health [37–40], one paper included CPGs for both a non-communicable disease in physical health and mental health [41] and one paper examined the introduction of a CPG for mental health [42]. …”

“…Five cluster randomised controlled trials (cluster RCTs) [37–41] and one uncontrolled before and after study (in mental health) [42] were included in the review.…”

“…Included studies were conducted in Brazil [37], China [38], Thailand [41], Nepal [39], South Africa [40] and Egypt [42]. Two studies were set in general hospitals in urban areas [37, 38].…”

Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand

“…8 Unnecessary use of antibiotics is seen among both health professionals and the public. [9][10][11][12] In European countries, systemic antibiotics are prescribed in the greatest volumes to ambulatory patients, mostly for respiratory tract infections. 13 In Thailand, a study in a tertiary care hospital revealed that only 7.9% of the upper respiratory tract infections (URIs) in the facility were caused by bacteria.…”