title: Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial.
abstract: BACKGROUND
  Management of acute maxillary sinusitis (AMS) is not optimal; antibiotics are often prescribed for viral sinusitis, which leads to many problems including those with antimicrobial resistance. Guidelines have been proposed as a means to change the professional practices.
  
  
  OBJECTIVE
  Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care.
  
  
  METHODS
  A multi-centre randomized controlled trial was conducted in 30 health centres (HCs) covering a population of 819 777 people from 1998 to 2002. The participating HCs were randomized to implement guidelines either according to a problem-based learning (PBL) or an academic detailing (AD) method facilitated by local GPs. Data were gathered during 1 week in November in all study years and also from external control HCs in 2002. The main outcome measure was compliance with the key points of AMS management in national Current Care guidelines.
  
  
  RESULTS
  Implementation of guidelines produced minor changes towards the recommended practices in the management of AMS. Use of the first-line drug amoxicillin increased slightly (from 39% to 48% in AD centres and from 33% to 45% in PBL centres, controls 40%). Proportion of courses of antibiotics with recommended duration increased in MIKSTRA study centres (from 34% to 40% in AD centres and from 32% to 47% in PBL centres, controls 43%).
  
  
  CONCLUSIONS
  A nationwide guidelines implementation project produced modest changes in the management of AMS. There were no significant differences between AD and PBL education methods. Less than half the HCs were able to realize the project as intended, which decreases the internal validity of the study. The guidelines implementation might have benefited of more focussed targets and approaches that took into account the problems and practices of each HC.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland. helena.varonen@duodecim.fi
authors.forename: Helena
authors.initials: H
authors.lastname: Varonen
authors.forename: Ulla-Maija
authors.initials: UM
authors.lastname: Rautakorpi
authors.forename: Solja
authors.initials: S
authors.lastname: Nyberg
authors.forename: Pekka O
authors.initials: PO
authors.lastname: Honkanen
authors.forename: Timo
authors.initials: T
authors.lastname: Klaukka
authors.forename: Erkki
authors.initials: E
authors.lastname: Palva
authors.forename: Risto
authors.initials: R
authors.lastname: Roine
authors.forename: Hannu
authors.initials: H
authors.lastname: Sarkkinen
authors.forename: Marjukka
authors.initials: M
authors.lastname: Mäkelä
authors.forename: Pentti
authors.initials: P
authors.lastname: Huovinen
mesh_terms: D000208:Acute Disease; D000890:Anti-Infective Agents; D004352:Drug Resistance, Microbial; D005194:Family Practice; D005387:Finland; D017408:Guidelines as Topic; D006801:Humans; D015523:Maxillary Sinusitis / Q000188:drug therapy* / Q000821:virology; D010818:Practice Patterns, Physicians' / Q000592:standards*; D013222:State Medicine
chemical_list: D000890:Anti-Infective Agents