IMPROVING PHYSICIAN PRESCRIBING PATTERNS TO TREAT RHINOPHARYNGITIS - INTERVENTION STRATEGIES IN 2 HEALTH SYSTEMS OF MEXICO

To improve prescribing practices for rhinopharyngitis, an interactive educational intervention and a managerial intervention were carried ou t in 18 primary care facilities in metropolitan Mexico City. Four fami ly medicine clinics of the Mexican Social Security Institute (IMSS) an d 14 health centres of the Ministry of Health (SSA) were included. A q uasi-experimental design was employed. One hundred and nineteen physic ians (IMSS 68, SSA 51) participated. Sixty-five physicians (IMSS 32, S SA 33) were in the study group, while 54 were in the control group (IM SS 36, SSA 18). The study had four stages: (I) baseline, to evaluate t he physicians' prescribing behaviour for rhinopharyngitis; (II) interv ention, using an interactive educational workshop and a managerial pee r review committee; (III) post-intervention evaluation of short-term i mpact; and (IV) follow-up evaluation of long-term effect 18 months aft er the workshop. The control group did not receive any intervention bu t was evaluated at the same time as the study group. At baseline, most patients in both institutions received antibiotic prescriptions (IMSS 85.2%, SSA 68.8%). After the workshop, the percentage of patients rec eiving antibiotic prescriptions in the IMSS went from 85.2% to 48.1%, while in the SSA it went from 68.8% to 49.1%. Appropriateness of treat ment was analyzed using the physician as the unit of analysis. At base line, 30% of IMSS physicians in the study group treated their patients appropriately. After the intervention, this percentage increased to 5 7.7%, and at the 18-month follow-up it was 54.2%. The SSA study group increased the appropriate use of antibiotics from 35.7% to 46.2%, with this percentage falling to 40.9% after the 18-month follow-up period. In the control group there were no significant changes in prescribing patterns with respect to either the prescribing of antibiotics or the appropriateness of treatment. The intervention strategies were succes sful in both institutions. Forty per cent of physicians improved their prescribing practices after the workshop, with this change remaining in 27.5% of them throughout the follow-up period. On the other hand, 4 2.5% of the physicians did not change their prescribing practices afte r the intervention. The rest (17.5%) showed appropriate prescribing pr actices during all the stages of the study. We conclude that it is pos sible to improve the physicians' prescribing practices through interac tive educational strategies and managerial interventions. This type of intervention can be an affordable way to provide continuing medical e ducation to primary care physicians who do not have access to continui ng educational activities, and to improve the quality of care they pro vide.