title: Effecting change in primary care management of respiratory  conditions: a global scoping exercise and literature review of  educational interventions to inform the IPCRG's E-Quality  initiative.
abstract: This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group  (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management  in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health  systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with  members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any  development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative  capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or  improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational  interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health  professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality  improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate.  The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider  the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or  improved health outcomes.
authors.affiliation: Education Consultant, International Primary Care Respiratory Group, London, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: McDonnell
authors.forename: Siân
authors.initials: S
authors.lastname: Williams
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.forename: Jaime
authors.initials: J
authors.lastname: Correia de Sousa
authors.forename: H John
authors.initials: HJ
authors.lastname: Fardy
authors.forename: Monica
authors.initials: M
authors.lastname: Fletcher
authors.forename: James
authors.initials: J
authors.lastname: Stout
authors.forename: Ron
authors.initials: R
authors.lastname: Tomlins
authors.forename: Osman M
authors.initials: OM
authors.lastname: Yusuf
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
mesh_terms: D004502:Education, Medical, Continuing; D005246:Feedback; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007407:Interviews as Topic; D008171:Lung Diseases / Q000628:therapy*; D008485:Medical Audit; D011320:Primary Health Care / Q000379:methods*