Health outcomes of asthma and COPD patients: the evaluation of a project to implement guidelines in general practice

Objective. To evaluate a project to implement guidelines on the management of patients with asthma or chronic obstructive pulmonary disease (COPD) in terms of the health outcomes of these patients. Design. A before-and-after study of 1 year with a non-randomized but comparable reference group. Setting. General practices in the Netherlands. Study participants. Two-hundred and eighty patients from 14 practices in the intervention group and 90 patients from five practices in the reference group (receiving usual care). Intervention. The project included a comprehensive implementation programme, involving identification of barriers, documentation of the care provided, specific education, feedback on compliance with the guidelines, and peer review. This project has been found to bring the process of care more in agreement with the guidelines. Main outcome measures. Mean peak expiratory flow rate (PEFR) as a percentage of the predicted value, number of days with a diurnal variation in PEFR greater than or equal to 15%, number of days with respiratory symptoms tall recorded by patients for a period of 14 days, and perceived health status (Nottingham Health Profile). Results. After 1 year, the intention group showed statistically significant improvements with regard to the mean PEFR, the diurnal variation in PEFR, respiratory symptoms and the pain score of the Nottingham Health Profile. Comparing the changes within the intervention group with the changes within the reference group, only a positive effect of the intervention on the mean PEFR was found. Conclusion. The comprehensive implementation programme improved the lung function and symptoms of asthma and COPD patients in the intervention group. However, in comparison with a reference group, the positive effect on the lung function was only small.