Health outcomes of asthma and COPD patients: the evaluation of a project to implement guidelines in general practice.
OBJECTIVE
To evaluate a project to implement guidelines on the management of patients with asthma or chronic obstructive pulmonany disease (COPD) in terms of the health outcomes of these patients.


METHODS
A before-and-after study of 1 year with a non-randomized but comparable reference group.


METHODS
General practices in the Netherlands.


METHODS
Two-hundred and eighty patients from 14 practices in the intervention group and 90 patients from five practices in the reference group (receiving usual care).


METHODS
The project included a comprehensive implementation programme, involving identification of barriers, documentation of the care provided, specific education, feedback on compliance with the guidelines, and peer review. This project has been found to bring the process of care more in agreement with the guidelines.


METHODS
Mean peak expiratory flow rate (PEFR) as a percentage of the predicted value, number of days with a diurnal variation in PEFR > or = 15%, number of days with respiratory symptoms (all recorded by patients for a period of 14 days), and perceived health status (Nottingham Health Profile).


RESULTS
After 1 year, the intervention group showed statistically significant improvements with regard to the mean PEFR, the diurnal variation in PEFR, respiratory symptoms and the pain score of the Nottingham Health Profile. Comparing the changes within the intervention group with the changes within the reference group, only a positive effect of the intervention on the mean PEFR was found.


CONCLUSIONS
The comprehensive implementation programme improved the lung function and symptoms of asthma and COPD patients in the intervention group. However, in comparison with a reference group, the positive effect on the lung function was only small.
Jans
M P
MP
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands. g.van.oss@hccnet.nl
Schellevis
F G
FG
Le Coq
E M
EM
Bezemer
P D
PD
van Eijk
J T
JT
D000328:Adult; D001249:Asthma / Q000628:therapy*; D015986:Confounding Factors, Epidemiologic; D019468:Disease Management; D004282:Documentation; D005194:Family Practice / Q000592:standards*; D005246:Feedback; D005260:Female; D006304:Health Status; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate; D018024:Peer Review, Health Care; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012107:Research Design; D016896:Treatment Outcome