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

Pagaiya, N. and Garner, Paul ORCID: (2005) 'Primary care nurses using guidelines in Thailand: a randomized controlled trial'. Tropical Medicine & International Health, Vol 10, Issue 5, pp. 471-477.

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BACKGROUND 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 = 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 = 0.029). Diabetes care was generally good, and changed little with guidelines.
CONCLUSION Staff at primary health centres over-prescribe antibiotics in children and tranquilizer in adults. Clinical guidelines implemented with workshops and educational outreach visits improved some but not all aspects of prescribing in the short-term.

Item Type: Article
Uncontrolled Keywords: clinical guidelines quality of care primary health care randomized controlled trial nurses health maintenance organization case-management adherence
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
QV Pharmacology > Drug Standardization. Pharmacognosy. Medicinal Plants > QV 748 Prescription writing. Dosage. Dosage calculations
WY Nursing > WY 100.4 Nursing assessment. Nursing diagnosis
WY Nursing > WY 20.5 Research (General)
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):
Depositing User: Martin Chapman
Date Deposited: 12 Sep 2011 13:54
Last Modified: 06 Sep 2019 10:14


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