Can small group education and peer review improve care for patients with asthma chronic obstructive pulmonary disease?

Objective-To study the effectiveness of an intensive small group education and peer review programme aimed at implementing national guidelines on asth ma/chronic obstructive pulmonary disease (COPD) on care provision by genera l practitioners (GPs) and on patient outcomes. Design-A randomised experimental study with pre-measurement and post-measur ement (after one year) in an experimental group and a control group in Dutc h general practice. Subjects and intervention-Two groups of GPs were formed and randomised. The education and peer review group (17 GPs with 210 patients) had an interven tion consisting of an interactive group education and peer review programme (four sessions each lasting two hours). The control group consisted of 17 GPs with 223 patients (no intervention). Main outcome measures-Knowledge skills, opinion about asthma and CORD care, presence of equipment in practice; actual performance about peakflow measu rement, non-pharmacological and pharmacological treatment; asthma symptoms (Dutch Medical Research Council), smoking habits, exacerbation ratio, and d isease specific quality of life (QOL-RIQ). Data were collected by a written questionnaire for GPs, by self recording of consultations by GPs, and by a written self administered questionnaire for adult patients with asthma/COP D. Results-Data from 34 GP questionnaires, 433 patient questionnaires, and rec ordings from 934 consultations/visits and 350 repeat prescriptions were ava ilable. Compared with the control group there were only significant changes for self estimated skills (+16%, 95% confidence interval 4% to 26%) and pr esence of peakflow meters in practice (+18%, p<0.05). No significant change s were found for provided care and patient outcomes compared with the contr ol group. In the subgroup of more severe patients, the group of older patie nts, and in the group of patients not using anti-inflammatory medication at baseline, no significant changes compared with the control group were seen in patient outcomes. Conclusion-Except for two aspects, intensive small group education and peer review in asthma and CORD care do not seem to be effective in changing rel evant aspects of the provided care by GPs in accordance with guidelines, no r in changing patients' health status.