title: The effect of an integrated syndromic respiratory disease guideline in primary health care settings.
abstract: OBJECTIVE
  The use of integrated syndromic guidelines (ISG) aims to improve the quality of care for patients with respiratory diseases. The impact of such ISG in clinical practice can be potentially significant in primary health care (PHC) settings. We report the impact of the use by general practitioners (GPs) of a Tunisian ISG for respiratory diseases in management of respiratory patients in PHC.
  
  
  METHODS
  The short-term impact was assessed through the results of the feasibility study. This study included a baseline survey, before training on ISG, and an impact survey, after training on ISG. The same 73 GPs practicing within 28 PHCs were involved in the two surveys at an interval of 6 weeks. Information on each patient mentioned gender, age, underlying conditions, symptoms, referral, diagnosis and drug prescription details.
  
  
  RESULTS
  During the periods of the baseline and impact surveys, 36.0 and 31.1% of PHC attendees, respectively, sought care for respiratory symptoms. Acute respiratory infection (ARI) cases accounted for more than 85% of patients with respiratory disease. In the impact survey, chronic respiratory disease (CRD) diagnosis increased by approximately 50%. In the same way, the proportion of tuberculosis suspects increased 5.5 times. The number of drugs prescribed per patient decreased by 18.8%, and the proportion of patients who were prescribed antibiotics decreased by 19.0%. The prescription of steroids also significantly decreased while inhaled β-agonist prescription increased. The average cost of drug prescription was reduced by 19%.
  
  
  CONCLUSIONS
  Training on ISG for respiratory diseases improved the diagnosis of CRD and tuberculosis, and lead to a more rational use of drugs for ARIs in PHCs.
authors.affiliation: Respiratory Diseases Department, FSI Hospital, La Marsa, Tunisia.
authors.forename: Maher
authors.initials: M
authors.lastname: Abouda
authors.affiliation: Abderrahmen Mami Hospital, d'Ariana, Tunisia.
authors.forename: Agnes
authors.initials: A
authors.lastname: Hamzaoui
authors.affiliation: Abderrahmen Mami Hospital, d'Ariana, Tunisia.
authors.forename: Ekram
authors.initials: E
authors.lastname: Drira
authors.affiliation: WHO, Djibouti, Djibouti.
authors.forename: Ridha
authors.initials: R
authors.lastname: Djebeniani
authors.affiliation: STOP TB, WHO, Geneva, Switzerland.
authors.forename: Salah
authors.initials: S
authors.lastname: Othmani
authors.affiliation: Abderrahmen Mami Hospital, d'Ariana, Tunisia.
authors.forename: Ali
authors.initials: A
authors.lastname: Ben Kheder
mesh_terms: D000208:Acute Disease; D000328:Adult; D001291:Attitude of Health Personnel; D058005:General Practitioners / Q000193:education / Q000592:standards*; D006801:Humans; D007318:Inservice Training; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy; D014416:Tunisia
keywords: clinical guidelines; health care; health economics