Nurses run primary health centres in Thailand. The authors examined whether clinical guidelines improved the quality of the care they provide. Eighteen nurse-led health centres were randomized to (a) guidelines, receiving a training workshop plus educational outreach visit, with guidelines for children (acute respiratory tract infection and diarrhoea) and adults (diazepam prescribing and diabetes management) or (b) usual care. Outcomes were changes at 6 months in antibiotic use, diazepam prescribing, drug costs per patient, and a composite process index for diabetes care. Conclusions drawn were that staff at primary health centres over-prescribe antibiotics in children and tranquilizer in adults. Clinical guidelines implemented with workshops and educational outreach visits improved some but not all aspects of prescribing in the short-term.
Tropical Medicine and International Health, 2005, 10, (5), pp. 471-477, [DOI: 10.1111/j.1365-3156.2005.01404.x]