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Related Experiment Videos

Primary care nurses using guidelines in Thailand: a randomized controlled trial.

Nonglak Pagaiya1, Paul Garner

  • 1Sirindhorn College of Public Health, Khon Kaen, Thailand. cnonglak@yahoo.com

Tropical Medicine & International Health : TM & IH
|April 30, 2005
PubMed
Summary

Clinical guidelines improved antibiotic prescribing for children with acute respiratory infections and reduced tranquilizer use in adults at Thai primary health centres. However, overall antibiotic prescribing and diabetes care showed minimal short-term changes.

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Area of Science:

  • Health Services Research
  • Clinical Pharmacy
  • Primary Health Care

Background:

  • Nurses manage primary health centers in Thailand.
  • The study assessed the impact of clinical guidelines on care quality provided by nurses.

Purpose of the Study:

  • To evaluate the effectiveness of clinical guidelines in improving healthcare quality in nurse-led primary health centers.
  • To assess changes in antibiotic use, diazepam prescribing, drug costs, and diabetes care processes.

Main Methods:

  • Eighteen nurse-led health centers were randomized to receive either clinical guidelines (with training and outreach) or usual care.
  • Outcomes measured included changes in antibiotic use, diazepam prescribing, drug costs, and a composite process index for diabetes care at 6 months.

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Main Results:

  • Antibiotic prescribing for acute respiratory infections in children decreased significantly in the intervention group (42% to 27%) compared to controls (27% to 30%, P=0.022), with reduced drug costs.
  • Diazepam prescribing in adults also decreased in the intervention group (17% to 10%) compared to controls (21% to 18%, P=0.029).
  • No significant changes were observed in antibiotic use for diarrhea or in the composite process index for diabetes care.

Conclusions:

  • Primary health center staff in Thailand over-prescribe antibiotics in children and tranquilizers in adults.
  • Clinical guidelines, when implemented with workshops and educational outreach, showed short-term improvements in specific prescribing practices but not all aspects of care.