Evaluating an educational intervention to improve the treatment of asthma in four European countries

In the international Drug Education Project, a new educational program for peer groups of doctors was developed and tested to improve the treatment of asthma patients in The Netherlands, Norway, Sweden, and Slovakia. Individu alized feedback on prescribing and the underlying decision strategy was pre sented and discussed within the group of doctors, in relation to existing g uidelines. In a parallel, randomized controlled design the effect on compet ence and actual prescribing was tested. Results were related to national gu idelines. In general, the program improved the doctors' attitudes as well a s some of their prescribing behavior. The proportion of patients treated wi th inhaled corticosteroids significantly improved in The Netherlands (effec t size 1.27), and the proportion of oral corticosteroid use for exacerbatio n treatment increased both in The Netherlands and in Norway (effect sizes 1 .99 and 0.87, respectively). Overall attitudes of Dutch and Norwegian docto rs also improved significantly (effect sizes 1.06 and 0.87, respectively), as did both knowledge (effect size 1.06) and attitudes (effect size 1.49) c oncerning exacerbation treatment in Slovakia. In Sweden no significant impr ovements could be measured. Conclusively, improvements in asthma treatment are possible with an educational program based on self-learning in small pe er groups, although effects in one health care setting may not occur in ano ther health care setting. Possible explaining factors may be different atti tudes to and experiences with guidelines as well as with continuing medical education programs, and differences in the opportunities for change, inclu ding prevailing trends in prescribing behavior.