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J Pak Med Assoc. 2016 Feb;66(2):174-8.

Effect of continued professional development on clinical performance in a public sector health care setting.

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Community Medicine Department, Army Medical College, Rawalpindi.
Community Medicine Department, Rawal Institute of Health Sciences, Islamabad.
Community Medicine Department, Biochemistry Department, Foundation University Medical College, Rawalpindi.



To determine the effectiveness of intervention by education of doctors in improving the referral rate and quality in a public-sector healthcare setting.


The quasi-experimental study was conducted from March to September 2012 at PNS Rahat Hospital in naval sailors' residential estate, Karsaz, Karachi. Two awareness sessions were held three months apart by a gynaecologist and a paediatrician. The sessions were aimed at communicating the consultant practice to female general practitioners employed at the two family welfare centres. Pre- and post-intervention data was collected manually from the record registers at the two centers as well as gynaecology and paediatrics outpatient clinics.


The study comprised 10 female GPs. In paediatric clinic, there was 47% (118 post intervention/ 187 pre intervention) reduction in referrals for acute gastroenteritis and fever of unknown origin (32 post intervention/75 pre intervention). In gynaecology, 30% (50 post intervention/61 pre intervention) reduction was seen in referrals for severe anaemia in 2nd and 3rd trimesters of pregnancy, and an increase in referrals (35 post intervention/19 pre intervention) for high-risk cases indicating better counselling and case identification. Improved standard of counselling was also reflected by 31% reduced referrals (40 post intervention/ 58 pre intervention) for hyper-emesis gravidarum during the first trimester. The difference in referrals was not statistically significant (p>0.05) for paediatrics, but it was highly significant (p<0.001) for gynaecology.


Healthcare system can function optimally with focus on referral standards and by improving the communication between the primary care physicians and consultants.


Healthcare system, Referral quality, Continued medical education, Communication.

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