From research to public health interventions. I. Impact of an educational strategy for physicians to improve treatment practices of common diseases

Abstract

Errors in treating common diseases occur very frequently in primary health care practice. While many of these mistakes are not life-threatening, the costs of abuse in drug prescription may be greatly increased. An educational strategy aimed to improve physicians' prescribing practices for acute diarrhea (AD) and acute respiratory infection (ARI) was developed as a research study, involving three medical care units. The strategy was largely based on promoting active participation of the trainees in the whole process, including: (a) group participation in a literature review of updated articles related to management of AD and ARI; (b) analysis of prescribing practices before the intervention; (c) participation in the development of a clinical algorithm for the therapeutic management of these illnesses; and (d) discussion of the usefulness of the algorithm during peer review committee meetings. Successful results of this intervention, as judged by the improvement of treatment practices and the persistence of changes for up to 2 years after the intervention, as well as its ease of application and low costs, motivated its extension to a health District and a State. In these sites, the intervention was in charge of medical leaders from the clinics and medical heads of the local health systems, respectively. The extension of the educational strategy was accompanied by a relative reduction in AD from 46.7% to 6.5% and in ARI from 32.6% to 8.5%. However, the benefit-cost ratio showed a dramatic increase when comparing results from the research study and from the State intervention, for both AD (from 3.3 to 4.4) and ARI (from 16.2 to 21.6), for an overall net increase of 33.3%. Based on these results, the educational strategy was adopted by the National Program for the Control of Diarrheal Diseases, and was used to train public health physicians throughout the country, from 1992 to 1994.