DO CLINICAL GUIDELINES INTRODUCED WITH PRACTICE-BASED EDUCATION IMPROVE CARE OF ASTHMATIC AND DIABETIC-PATIENTS - A RANDOMIZED CONTROLLED TRIAL IN GENERAL PRACTICES IN EAST LONDON

Objective-To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve qua lity of care in non-training, inner city general practices. Design-Ran domised controlled trial with each practice receiving one set of guide lines but providing data on the management of both conditions. Subject s-24 inner city, non-training general practices. Setting-East London. Main outcome measures-Recording of key variables in patient records (a sthma: peak flow rate, review of inhaler technique, review of asthma s ymptoms, prophylaxis, occupation, and smoking habit; diabetes: blood g lucose concentration, glycaemic control, funduscopy, feet examination, weight, and smoking habit); size of practice disease registers; presc ribing in asthma; and use of structured consultation ''prompts.'' Resu lts-In practices receiving diabetes guidelines, significant improvemen ts in recording were seen for all seven diabetes variables. Both group s of practices showed improved recording of review of inhaler techniqu e, smoking habit, and review of asthma symptoms. In practices receivin g asthma guidelines, further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma. Siz es of disease registers were unchanged. The use of structured prompts was associated with improved recording of four of seven variables on d iabetes and all six variables on asthma. Conclusions-Local guidelines disseminated via practice based education improve the management of di abetes and possibly of asthma in inner city, nontraining practices. Th e use of simple prompts may enhance this improvement.