background Nurses run primary health centres in Thailand. We examined whether clinical guidelinesimproved the quality of the care they provide.methods Eighteen nurse-led health centres randomized to (a) guidelines, receiving a training workshopplus educational outreach visit, with guidelines for children (acute respiratory tract infection anddiarrhoea) and adults (diazepam prescribing and diabetes management) or (b) usual care. Outcomeswere changes at 6 months in antibiotic use, diazepam prescribing, drug costs per patient, and acomposite process index for diabetes care.results Baseline prescribing was high for antibiotics (37% of all attendees), and no differencebetween intervention and control sites was detected at follow-up for this variable. In children (0–5 yearsold), antibiotics were widely used for acute respiratory tract infection (34%), and fell with guidelines(intervention: 42% at baseline to 27% at follow-up; control: 27–30%, P ¼ 0.022), with an associatedfall in drug costs per patient. Antibiotics were widely prescribed for diarrhoea in children (91%), but nochange was detected with guidelines. In adults, diazepam prescribing at baseline was high (17%), andfell in the guidelines group (intervention: 17–10%; control 21–18%; P ¼ 0.029). Diabetes care wasgenerally good, and changed little with guidelines.conclusion Staff at primary health centres over-prescribe antibiotics in children and tranquilizer inadults. Clinical guidelines implemented with workshops and educational outreach visits improved somebut not all aspects of prescribing in the short-term.

Tropical medicine & international health ปี 2548, May ปีที่: 10 ฉบับที่ 5 หน้า 471-477

care, Health, of, Primary, controlled, randomized, trial, clinical, guidelines, nurses, Quality