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Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial
Helena Varonen1, Ulla-Maija Rautakorpi, Solja Nyberg
1Finnish Institute of Occupational Health, Helsinki, Finland. helena.varonen@duodecim.fi
Background:
Management of acute maxillary sinusitis (AMS) is not optimal; antibiotics are often prescribed for viral sinusitis, which leads to many problems including those with antimicrobial resistance. Guidelines have been proposed as a means to change the professional practices.
Objective:
Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care.
Methods:
A multi-centre randomized controlled trial was conducted in 30 health centres (HCs) covering a population of 819 777 people from 1998 to 2002. The participating HCs were randomized to implement guidelines either according to a problem-based learning (PBL) or an academic detailing (AD) method facilitated by local GPs. Data were gathered during 1 week in November in all study years and also from external control HCs in 2002. The main outcome measure was compliance with the key points of AMS management in national Current Care guidelines.
Results:
Implementation of guidelines produced minor changes towards the recommended practices in the management of AMS. Use of the first-line drug amoxicillin increased slightly (from 39% to 48% in AD centres and from 33% to 45% in PBL centres, controls 40%). Proportion of courses of antibiotics with recommended duration increased in MIKSTRA study centres (from 34% to 40% in AD centres and from 32% to 47% in PBL centres, controls 43%).
Conclusions:
A nationwide guidelines implementation project produced modest changes in the management of AMS. There were no significant differences between AD and PBL education methods. Less than half the HCs were able to realize the project as intended, which decreases the internal validity of the study. The guidelines implementation might have benefited of more focussed targets and approaches that took into account the problems and practices of each HC.
Insights
Implementing national guidelines for acute maxillary sinusitis (AMS) showed modest improvements in antibiotic prescribing. However, changes were minor, indicating a need for more focused approaches to optimize AMS management in primary care.
Area of Science:
- Primary care research
- Evidence-based medicine
- Health services research
Background:
- Suboptimal management of acute maxillary sinusitis (AMS) contributes to antibiotic resistance.
- National guidelines aim to standardize AMS care and improve professional practices.
Purpose of the Study:
- To evaluate the impact of a nationwide guidelines implementation program on AMS management in primary care.
- To compare the effectiveness of problem-based learning (PBL) and academic detailing (AD) methods for guideline implementation.
Main Methods:
- Multi-center randomized controlled trial involving 30 health centers (population 819,777).
- Randomized allocation to PBL or AD guideline implementation methods.
- Data collection over multiple years, including external control centers for comparison.
Main Results:
- Minor improvements observed in adherence to recommended AMS management practices.
- Slight increase in amoxicillin use and appropriate antibiotic duration, with no significant difference between PBL and AD methods.
- Less than half of participating centers fully implemented the project as intended.
Conclusions:
- Nationwide guideline implementation yielded modest changes in AMS management.
- No significant difference was found between academic detailing and problem-based learning educational approaches.
- Study limitations include decreased internal validity due to incomplete implementation; more targeted strategies may enhance guideline adoption.
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