Abstract
BackgroundA cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops.MethodsTwenty-nine practices were randomly allocated to one of three study arms. Australian asthma management guidelines were adapted to accommodate characteristics of the local area. GPs in the intervention arm (Group 1, n = 18 GPs) participated in a small group based education program and were provided with the adapted guidelines. One control arm (Group 2, n = 18 GPs) received only the adapted guidelines, while the other control arm (Group 3, n = 15 GPs) received an unrelated education intervention. GPs' knowledge, attitudes and management of paediatric asthma was assessed.ResultsPost intervention, intervention arm GPs were no more likely to provide a written asthma action plan, but were better able to assess the severity of asthma attack (Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01), better able to identify patients at high risk of severe attack (Group 1vs Group 3 p = 0.06), and tended to score higher on the asthma knowledge questionnaire (Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2). Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma.ConclusionUsing interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP's knowledge and confidence to manage asthma, but did not change GP's self-reported provision of written action plans.
Highlights
A cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops
There was no evidence supporting the hypothesis that General Practitioners (GPs) in the intervention group were more likely to report providing a written asthma action plan to children compared to GPs in the two control groups (Group 1 vs Group 2: OR = 1.15, 95% confidence interval (CI): 0.14 to 9.4, P = 0.89; and Group 1 vs Group 3: OR = 3.8, 95% CI 0.50 to 28.4, P = 0.20)
Post-intervention, there was some evidence suggesting that GPs in the intervention group had increased their knowledge about asthma and were better able to assess the severity of asthma attack
Summary
A cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops. Australian General Practitioners (GPs) see 90% of Australians at least once annually [5] and are ideally placed to coordinate the care of patients with asthma; they are still under-diagnosing asthma and under-treating with inhaled steroids. In an attempt to standardise asthma education and management, and reduce variability in patient care, clinical guidelines have been developed in Australia [6,7] and internationally. Recent studies in Australia indicate that recommendations are often not implemented in clinical practice [8], suggesting a need for more effective and innovative dissemination and implementation strategies [9]. The local adaptation of national guidelines has been proposed as a way of reversing this trend as it provides the benefit of local ownership, while maintaining scientific validity [10]
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