• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of bmjBMJ helping doctors make better decisionsSearch bmj.comLatest content
BMJ. Dec 2, 1995; 311(7018): 1473–1478.
PMCID: PMC2543702

Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London.

Abstract

OBJECTIVE--To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training, inner city general practices. DESIGN--Randomised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions. SUBJECTS--24 inner city, non-training general practices. SETTING--East London. MAIN OUTCOME MEASURES--Recording of key variables in patient records (asthma: peak flow rate, review of inhaler technique, review of asthma symptoms, prophylaxis, occupation, and smoking habit; diabetes: blood glucose concentration, glycaemic control, funduscopy, feet examination, weight, and smoking habit); size of practice disease registers; prescribing in asthma; and use of structured consultation "prompts." RESULTS--In practices receiving diabetes guidelines, significant improvements in recording were seen for all seven diabetes variables. Both groups of practices showed improved recording of review of inhaler technique, smoking habit, and review of asthma symptoms. In practices receiving asthma guidelines, further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma. Sizes of disease registers were unchanged. The use of structured prompts was associated with improved recording of four of seven variables on diabetes and all six variables on asthma. CONCLUSIONS--Local guidelines disseminated via practice based education improve the management of diabetes and possibly of asthma in inner city, non-training practices. The use of simple prompts may enhance this improvement.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Delamothe T. Wanted: guidelines that doctors will follow. BMJ. 1993 Jul 24;307(6898):218–218. [PMC free article] [PubMed]
  • Haines A, Feder G. Guidance on guidelines. BMJ. 1992 Oct 3;305(6857):785–786. [PMC free article] [PubMed]
  • Graffy JP, Williams J. Purchasing for all: an alternative to fundholding. BMJ. 1994 Feb 5;308(6925):391–394. [PMC free article] [PubMed]
  • Jarman B. Underprivileged areas: validation and distribution of scores. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1587–1592. [PMC free article] [PubMed]
  • Harris MI, Hadden WC, Knowler WC, Bennett PH. International criteria for the diagnosis of diabetes and impaired glucose tolerance. Diabetes Care. 1985 Nov-Dec;8(6):562–567. [PubMed]
  • Naish J, Sturdy P, Toon P. Appropriate prescribing in asthma and its related cost in east London. BMJ. 1995 Jan 14;310(6972):97–100. [PMC free article] [PubMed]
  • Mittman BS, Tonesk X, Jacobson PD. Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. QRB Qual Rev Bull. 1992 Dec;18(12):413–422. [PubMed]
  • Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990 Jan 26;263(4):549–556. [PubMed]
  • Patchett P, Roberts D. Diabetic patients who do not have diabetes: investigation of register of diabetic patients in general practice. BMJ. 1994 May 7;308(6938):1225–1226. [PMC free article] [PubMed]
  • Parnell SJ, Zalin AM, Clarke CW. Care of diabetic patients in hospital clinics and general practice clinics: a study in Dudley. Br J Gen Pract. 1993 Feb;43(367):65–69. [PMC free article] [PubMed]
  • Rethans JJ, Martin E, Metsemakers J. To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients. Br J Gen Pract. 1994 Apr;44(381):153–156. [PMC free article] [PubMed]
  • Grimshaw JM, Russell IT. Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual Health Care. 1994 Mar;3(1):45–52. [PMC free article] [PubMed]
  • Benett IJ, Lambert C, Hinds G, Kirton C. Emerging standards for diabetes care from a city-wide primary care audit. Diabet Med. 1994 Jun;11(5):489–492. [PubMed]
  • O'Connell S. Lyme disease in the United Kingdom. BMJ. 1995 Feb 4;310(6975):303–308. [PMC free article] [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...