Article type
Year
Abstract
Background: Clinical guidelines continue to be widely used as a strategy to
improve professional practice in medical practice and it appears that
guideline-driven care was effective in changing the process and outcomes of care provided by nurses in high income countries. However, it should not be assumed that such clinical guideline implementations would function equally as effectively in nurses working in isolation at rural primary care in middle
and low income countries.
Objectives: To assess the effects of the clinical guidelines used by nurses at primary care settings in middle and low income countries on the process of care and patient outcomes.
Methods: We searched the Cochrane Effective Practice and Organisation of Care Groups register up to January 2004. This was supplemented with searches of MEDLINE (1975-2004), CINAHL (1982 2004), and reference lists.
Randomised control trial (RCT), controlled before and after (CBA), and interrupted time series (ITS) that reported objectively measured professional practice in a health care setting or health care outcomes and the studies that were carried on at rural primary care in middle- and low-income countries were included.
Two reviewers independently extracted data and assessed study quality.
Results: Three studies were included involving more than 102 nurses from 102 rural primary care units. The reporting of study methods was adequate for one of two studies. All but one study used settings as the units of allocation, but patients were used as unit of analysis. In all studies, wide range of services were targeted. All studies targeted at acute respiratory infection and diarrhoea. Other behaviour targeted included diazepam prescribing in adults, urethral discharge in men, and genital ulcer disease. All studies observed improvements in prescribing behaviour of nurses. Guideline implementations in 3 studies reported significant improvement of guideline adherence, reduction of antibiotic prescribing. One study reported the significant reduction of diazepam prescribing in adults.
Conclusions: There is some evidence that guideline-driven care is effective in changing process of care provided by nurses working in rural primary care. However, caution is needed in generalising findings to other settings, as few studies were included. It is necessary that more studies using rigorous study design should introduced, to allow further evaluation and increase the base of studies from which to draw evidence.
References: 1. Meyer, JC; Summers, RS and Holler, H. Randomised, controlled trial of prescribing training in a South Africa province. Med Educ. 2001;35 (9):833. 2. Pagaiya N, Garner P. Primary care nurses using guidelines in Thailand: a randomised controlled trial (Unpublished). 2003. 3. Trap B, Todd CH, Moore H, Laing R. The impact of supervision on stock management and adherence to treatment guidelines: a randomised controlled trial. Health Policy Plan. 2001;16(3): 273-280.
improve professional practice in medical practice and it appears that
guideline-driven care was effective in changing the process and outcomes of care provided by nurses in high income countries. However, it should not be assumed that such clinical guideline implementations would function equally as effectively in nurses working in isolation at rural primary care in middle
and low income countries.
Objectives: To assess the effects of the clinical guidelines used by nurses at primary care settings in middle and low income countries on the process of care and patient outcomes.
Methods: We searched the Cochrane Effective Practice and Organisation of Care Groups register up to January 2004. This was supplemented with searches of MEDLINE (1975-2004), CINAHL (1982 2004), and reference lists.
Randomised control trial (RCT), controlled before and after (CBA), and interrupted time series (ITS) that reported objectively measured professional practice in a health care setting or health care outcomes and the studies that were carried on at rural primary care in middle- and low-income countries were included.
Two reviewers independently extracted data and assessed study quality.
Results: Three studies were included involving more than 102 nurses from 102 rural primary care units. The reporting of study methods was adequate for one of two studies. All but one study used settings as the units of allocation, but patients were used as unit of analysis. In all studies, wide range of services were targeted. All studies targeted at acute respiratory infection and diarrhoea. Other behaviour targeted included diazepam prescribing in adults, urethral discharge in men, and genital ulcer disease. All studies observed improvements in prescribing behaviour of nurses. Guideline implementations in 3 studies reported significant improvement of guideline adherence, reduction of antibiotic prescribing. One study reported the significant reduction of diazepam prescribing in adults.
Conclusions: There is some evidence that guideline-driven care is effective in changing process of care provided by nurses working in rural primary care. However, caution is needed in generalising findings to other settings, as few studies were included. It is necessary that more studies using rigorous study design should introduced, to allow further evaluation and increase the base of studies from which to draw evidence.
References: 1. Meyer, JC; Summers, RS and Holler, H. Randomised, controlled trial of prescribing training in a South Africa province. Med Educ. 2001;35 (9):833. 2. Pagaiya N, Garner P. Primary care nurses using guidelines in Thailand: a randomised controlled trial (Unpublished). 2003. 3. Trap B, Todd CH, Moore H, Laing R. The impact of supervision on stock management and adherence to treatment guidelines: a randomised controlled trial. Health Policy Plan. 2001;16(3): 273-280.