[Effectiveness of the implementation of a clinical program (CP) for the management of acute pharyngitis in adults].
OBJECTIVE
To reduce variability in the diagnosis and treatment of acute pharyngitis, reaching an established standard of quality.


METHODS
Noncontrolled intervention study, consisting of sequential quality improvement cycles.


METHODS
Unscheduled attention at the outpatient clinic of an internal medicine service.


METHODS
a baseline sample and 7 bimonthly follow-up samples were randomly selected from 2764 visits for acute pharyngitis and tonsillitis, resulting in a total sample of 910 visits. We include patients of both sexes who were at least 15 years old. A staff of 19 physicians are in charge of the outpatient clinic. Seventy five visits (8.2%) were eliminated because of lack of data. INTERVENTIONS (CLINICAL PROGRAM): a) elaboration of the CP; b) information to the physicians; c) monitoring of the indicators every two months; and d) introduction of corrective measures after the basal measurement and after each monitoring, including the communication to the professionals of the global and individual results.


METHODS
The following indicators were obtained from the computerized medical record: use of rapid antigen test for streptococcus (URAT), total antibiotic prescription (TAP), suitable antibiotic use (SAU) and first choice antibiotic selection (FCAS). The respective standards were adapted from international guidelines with the consensus of the intervening professionals, namely: URAT 50%; TAP 20%; SAU 100% and FCAS 100%.


METHODS
the indicators temporal variations were analyzed according the chi square test for linear trend.


RESULTS
the URAT increased significantly from the basal 30% and reached the 50% standard (P=.01). The basal TAP was 36% and it did not change significantly with the intervention (P=.53). The SAU improved significantly from basal 34% to values between 60 and 80% (P<.0001), about half of the maximal attainable improvement. The FCAS was 18% in the basal sample and climbed to 75% in the last measurements (P<.0001), about two thirds of the maximal attainable improvement.


CONCLUSIONS
Although the physicians' attitude has changed, it is still a long way from the established standard. It is necessary to maintain the monitoring of the quality indicators and the regular and customized interventions until the consolidation of the practice is achieved.
Irurzun
C
C
Servicio de Clínica Médica, Centro Medicus, Buenos Aires, Argentina.
González
M
M
Recondo
M
M
Urtasun
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy*; D015397:Program Evaluation