Implementation of clinical practice guidelines for upper respiratory infection in Thailand.

OBJECTIVE: To determine the effectiveness of implementing clinical practice guidelines (CPG) on antibiotic prescribing for adults with upper respiratory infection (URI) in terms of the changes in diagnosis and prevalence and patterns of antibiotic prescribing.
METHODS: The CPG on antibiotic treatments for adults with URI published in the Annals of Internal Medicine 2001; 134: 479-52 were considered to be of high quality and applicable to Thai patients. A one-page clinical practice protocol in Thai was prepared from these guidelines. The dissemination strategy provided CPG and clinical practice protocol to 12 general practitioners in Siriraj Social Security Program in Bangkok during interactive educational meetings in April 2001. The information on 837 URI episodes from January to March (pre-CPG phase) and 774 URI episodes during May to July (post-CPG phase) were extracted from the patients' medical records. Telephone follow up for patients without antibiotics in the post-CPG phase was also attempted.
RESULTS: Changes in the post-CPG period included (1) The diagnosis of URI was used less frequently whereas the diagnosis of common cold, pharyngitis and acute bronchitis were used more frequently (p<0.05). (2) Antibiotic use fell from 74.0% to 44.1% (p<0.001). (3) Fewer prescriptions for amoxicillin, roxithromycin, co-trimoxazole and doxycycline, and more for penicillin V (p<0.05). Patients (n=97) not given antibiotics reported recovery in 83.5% and improvement in 16.5%.
CONCLUSION: A locally prepared clinical practice protocol based on US CPG for appropriate antibiotic use for URI combined with interactive educational meetings is effective in promoting appropriate diagnosis and antibiotic therapy in an ambulatory setting in a tertiary care hospital in Thailand.