title: Improving general practice care of patients with asthma or chronic obstructive pulmonary disease: evaluation of a quality system.
abstract: BACKGROUND
  During the past decade, several guidelines on the management of chronic obstructive pulmonary disease and asthma have been developed. However, strategies for implementing these guidelines have not been systematically evaluated.
  
  
  OBJECTIVE
  To test a quality system intended to improve general practitioners' compliance with recently established guidelines.
  
  
  METHODS
  Before-after study with concurrent controls. UNIT OF ANALYSIS: 19 general medical practices in the Netherlands (14 intervention practices and 5 control practices).
  
  
  METHODS
  A quality system with five components: identification of barriers, documentation, education, feedback, and peer review.
  
  
  METHODS
  Outpatients 16 to 70 years of age with asthma or chronic obstructive pulmonary disease.
  
  
  METHODS
  The number of consultations for respiratory symptom monitoring, measurement of peak expiratory flow rate, prescription of anti-inflammatory agents, monitoring of medication compliance and inhalation technique, and influenza vaccination.
  
  
  RESULTS
  The percentage of patients who had two or more consultations per year increased significantly in the intervention practices (median, 27% of patients before the intervention vs 82% of patients after the intervention; P < 0.01), as did the percentage of patients who had at least one measurement of peak expiratory flow rate (median, 10% of patients before the intervention vs 84% of patients after the intervention; P < 0.01). The percentage of patients who received a prescription for anti-inflammatory agents did not increase significantly. No significant changes were seen in the control practices. Physicians in the intervention practices were more likely to monitor medication compliance and inhalation technique. No difference was found in frequency of influenza vaccination.
  
  
  CONCLUSIONS
  The quality system improved guideline compliance in some areas but not in others.
authors.affiliation: Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Amsterdam, The Netherlands. g.van.oss@hccnet.nl
authors.forename: M P
authors.initials: MP
authors.lastname: Jans
authors.forename: F G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: W
authors.initials: W
authors.lastname: Van Hensbergen
authors.forename: J T
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D018709:Statistics, Nonparametric