OBJECTIVE: To evaluate the effect on antibiotic prescribing of an intervention in existing local quality circles promoting an evidence-based guideline for acute rhinosinusitis. DESIGN: A pragmatic cluster-randomised controlled trial comparing standard dissemination of the guideline by mail with an additional strategy using quality circles. SETTING: General practice in Flanders, Belgium. PARTICIPANTS: General practitioners (GPs) in 18 local quality circles were randomly allocated to two study arms. All GPs received the guideline by mail. GPs in the nine quality circles allocated to the intervention arm received an additional group intervention, which consisted of one self-led meeting using material introduced to the group moderator by a member of the research team. MAIN OUTCOME MEASURES: Adherence to the guideline was measured as differences in the proportion of antibiotic prescriptions, including the choice of antibiotic, between the two study arms after the intervention period. GPs registered their encounters with patients presenting with signs and symptoms of acute rhinosinusitis in a booklet designed for the study. RESULTS:A total of 75 doctors (29% of GPs in the participating quality circles) registered 408 consultations. In the intervention group, 56.9% of patients received an antibiotic compared with 58.3% in the control group. First-choice antibiotics were issued in 34.5% of antibiotic prescriptions in the intervention group compared with 29.4% in the control group. After adjusting for patient and GP characteristics, the ORadj for antibiotics prescribed in the intervention arm compared with the control arm was 0.63 (95% CI 0.29 to 1.37). There was no effect on the choice of antibiotic (ORadj 1.07, 95% CI 0.34 to 3.37). CONCLUSION: A single intervention in quality circles of GPs integrated in the group's normal working procedure did not have a significant effect on the quality of antibiotic prescribing. More attention to the context and structure of primary care practice, and insight into the process of self-reflective learning may provide clues to optimise the effectiveness of quality circles.
RCT Entities:
OBJECTIVE: To evaluate the effect on antibiotic prescribing of an intervention in existing local quality circles promoting an evidence-based guideline for acute rhinosinusitis. DESIGN: A pragmatic cluster-randomised controlled trial comparing standard dissemination of the guideline by mail with an additional strategy using quality circles. SETTING: General practice in Flanders, Belgium. PARTICIPANTS: General practitioners (GPs) in 18 local quality circles were randomly allocated to two study arms. All GPs received the guideline by mail. GPs in the nine quality circles allocated to the intervention arm received an additional group intervention, which consisted of one self-led meeting using material introduced to the group moderator by a member of the research team. MAIN OUTCOME MEASURES: Adherence to the guideline was measured as differences in the proportion of antibiotic prescriptions, including the choice of antibiotic, between the two study arms after the intervention period. GPs registered their encounters with patients presenting with signs and symptoms of acute rhinosinusitis in a booklet designed for the study. RESULTS: A total of 75 doctors (29% of GPs in the participating quality circles) registered 408 consultations. In the intervention group, 56.9% of patients received an antibiotic compared with 58.3% in the control group. First-choice antibiotics were issued in 34.5% of antibiotic prescriptions in the intervention group compared with 29.4% in the control group. After adjusting for patient and GP characteristics, the ORadj for antibiotics prescribed in the intervention arm compared with the control arm was 0.63 (95% CI 0.29 to 1.37). There was no effect on the choice of antibiotic (ORadj 1.07, 95% CI 0.34 to 3.37). CONCLUSION: A single intervention in quality circles of GPs integrated in the group's normal working procedure did not have a significant effect on the quality of antibiotic prescribing. More attention to the context and structure of primary care practice, and insight into the process of self-reflective learning may provide clues to optimise the effectiveness of quality circles.
Authors: Mieke L van Driel; An De Sutter; Myriam Deveugele; Wim Peersman; Christopher C Butler; Marc De Meyere; Jan De Maeseneer; Thierry Christiaens Journal: Ann Fam Med Date: 2006 Nov-Dec Impact factor: 5.166
Authors: Alike W van der Velden; Eefje J Pijpers; Marijke M Kuyvenhoven; Sarah K G Tonkin-Crine; Paul Little; Theo J M Verheij Journal: Br J Gen Pract Date: 2012-12 Impact factor: 5.386
Authors: Christopher C Butler; Sharon A Simpson; Frank Dunstan; Stephen Rollnick; David Cohen; David Gillespie; Meirion R Evans; M Fasihul Alam; Marie-Jet Bekkers; John Evans; Laurence Moore; Robin Howe; Jamie Hayes; Monika Hare; Kerenza Hood Journal: BMJ Date: 2012-02-02
Authors: Sharon A Simpson; Christopher C Butler; Kerry Hood; David Cohen; Frank Dunstan; Meirion R Evans; Stephen Rollnick; Laurence Moore; Monika Hare; Marie-Jet Bekkers; John Evans Journal: BMC Fam Pract Date: 2009-03-23 Impact factor: 2.497
Authors: Mieke L van Driel; Simon Morgan; Amanda Tapley; Lawrie McArthur; Patrick McElduff; Lucy Yardley; Anthea Dallas; Laura Deckx; Katie Mulquiney; Joshua S Davis; Andrew Davey; Kim Henderson; Paul Little; Parker J Magin Journal: BMC Fam Pract Date: 2016-06-06 Impact factor: 2.497