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Improving Private Practitioners’

Improving Private Practitioners’ Adherence to Clinical Practice Guidelines: A Quasi-Experimental Study in the Philippines. Saniel MC, Acuin CS, Arciaga RS, Lansang MD, NaidasOD, Sevilleja JEAD, Bustos MV, Balis AC, Ross-Degnan D. Abstract. Problem Definition.

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Improving Private Practitioners’

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  1. Improving Private Practitioners’ Adherence to Clinical Practice Guidelines: A Quasi-Experimental Study in the Philippines Saniel MC, Acuin CS, Arciaga RS, Lansang MD, NaidasOD, Sevilleja JEAD, Bustos MV, Balis AC, Ross-Degnan D

  2. Abstract

  3. Problem Definition • Considerable variation in the practice or delivery of healthcare, including prescribing of antibiotics • Reduced quality of care, increased costs and adverse health outcomes of irrational antibiotic use

  4. Problem Definition • Strategy to address the problem: development and implementation of clinical practice guidelines (CPG) • Few studies to evaluate effect of CPG dissemination strategies on prescribing behavior of private practitioners in developing country setting

  5. Objective • To compare the effectiveness of problem based-lecture discussion (LD) versus interactive case-oriented session (ICS), each combined with feedback discussions (FD) of practice data, as strategies for improving diagnostic and antibiotic prescribing practices of private physicians for acute cystitis

  6. Study Design

  7. Methods • Pre- and post- quasi experimental design • Data collected thru carbonless prescription pads • Outcomes assessed before and after intervention: percentage of prescriptions adhering to CPG recommendations for acute cystitis on (1) antibiotic choice, dosage, and duration and (2) appropriate use of lab tests

  8. MethodsDescription of Interventions A. Problem based lecture discussion • 45-minute problem based lecture on guideline recommendations by an expert in the field followed by an open forum B. Interactive case-oriented session • Participants responded to questions about diagnosis and management of 5 Acute UTI cases using electronic keypads • Aggregate responses were displayed and discussed with an expert panel

  9. MethodsDescription of Interventions C. Feedback session • Individual prescription data over a 6 month period were aggregated and presented to participating MDs as part of a group discussion of issues on adherence to the CPGs

  10. Methods • Statistical analyses: • Descriptive statistics and bivariate analysis to compare the socio-demographic characteristics of physicians • Multivariate analysis using hierarchical cluster models for logistic outcomes (Glimmix, SAS v. 9) to compare outcomes at each measurement period

  11. Results * ICS – Interactive Case-Oriented Discussion* LD – Lecture-Style Discussion

  12. Results Adherence to recommended antibiotic regimen at baseline and after the dissemination strategies (Acute Cystitis, Non-Pregnant) OR=140 16-1205 OR=57 15-205 OR=95 11-818 % adherence % adherence OR=4 1-18 n=384 n=378 n=307 n=316 n=309 n=516 Group A Group B

  13. Results Adherence to recommended antibiotic regimen at baseline and after the dissemination strategies (Acute Cystitis, Pregnant) OR=2.2 1.3-3.9 OR=0.7 0.4-1.1 OR=0.7 0.4-1.2 OR=0.5 0.3-1.0 % adherence % adherence n=145 n=129 n=118 n=130 n=175 n=162 Group A Group B

  14. Results Adherence to guidelines for laboratory testing at baseline and after the dissemination strategies (Acute Cystitis, Non-Pregnant) OR=0.4 0.3-0.7 OR=0.7 0.5-1.1 OR=0.6 0.5-0.9 OR=0.8 0.6-1.2 % adherence % adherence n=384 n=378 n=307 n=316 n=309 n=516 Group A Group B

  15. Results Adherence to guidelines for laboratory testing at baseline and after the dissemination strategies (Acute Cystitis, Pregnant) OR=5.7 3.2-10.0 OR=3.6 2.1-6.2 OR=2.0 1.1-3.6 OR=1.1 0.6-2.0 % adherence % adherence n=145 n=129 n=118 n=130 n=175 n=162 Group A Group B

  16. Conclusions & Recommendations • Motivated physicians in the private sector in developing countries can and do improve their performance given evidence-based practice guidelines • Combined multifaceted strategies are more effective than single interventions in changing behavior

  17. Conclusions & Recommendations • Educational strategies that allow interactive discussion and feedback are more likely to change behavior than one-way communication approaches • Such strategies should be integrated within the continuing medical education programs of specialty societies and quality improvement efforts of health facilities

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