Improving drug treatment in general practice

In the international Drug Education Project, an educational program involvi ng auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care . Individualized feedback was provided and discussed in 24 Dutch peer group s showing doctors their prescribing practices and underlying reasons for tr eatment. A parallel, randomized controlled design was used to test the effe ct on competence and actual prescribing; in one study arm doctors received feedback on asthma treatment and in the other on UTI treatment. Especially the messages to treat asthma exacerbations with oral corticosteroids (17% i ncrease) and to prescribe short courses for UTI (decrease duration of 1.8 d ays) brought about large improvements. Both messages concerned acute situat ions, and were clear and relatively easy for GPs to implement. GPs will exp erience more barriers when changing maintenance treatment of an asthma pati ent, which could explain the more limited success of this part of the educa tional program: the proportion of patients treated with inhaled corticoster oids increased 5%. A ceiling effect was experienced regarding drug choice f or UTI. (C) 2000 Elsevier Science Inc. All rights reserved.