Can we improve the management of chronic obstructive respiratory disease? The example of asthma in adults.

SETTING: Zeralda health district, Algeria.
OBJECTIVE: To analyse the impact of asthma refresher courses on the knowledge, attitudes and practice of general practitioners (GPs) working in primary health centres (PHC); to improve the system of referral between the PHCs and the district reference centre; and to measure the impact of the intervention on the management of asthma patients.
METHODS: Before and after study: situation analysis with an epidemiological survey in the general population and a study of the demand for care in three PHCs and an emergency department, three refresher training workshops for voluntary GPs and adoption of new consensual methods of collaboration.
RESULTS: Despite a district asthma prevalence of 1.6%, patients were usually seen in emergency situations and sent to the district reference centre for follow-up. The refresher courses were attended by 56 GPs. Apart from improvements in knowledge, their practices and prescribing habits changed, with more beta-agonists (68.5% after vs. 12% before) and inhaled anti-inflammatories (52% vs. 0%), and less theophylline (2% vs. 55%), antibiotics (13% vs. 59%) and mucolytics (9% vs. 73.5%). The referral system was improved as follows: 69 health personnel were trained by GPs, recording and reporting forms designed during the workshops were implemented, essential emergency drugs were identified and collaboration between GPs and specialists at the reference centre was enhanced.