Improving general practice care of patients with asthma or chronic obstructive pulmonary disease: evaluation of a quality system.

Context: During the past decade, several guidelines on the management of chronic obstructive pulmonary disease and asthma have been developed. However, strategies for implementing these guidelines have not been systematically evaluated. Objective: To test a quality system intended to improve general practitioners' compliance with recently established guidelines. Design: Before-after study with concurrent controls. Unit of analysis: 19 general medical practices in the Netherlands (14 intervention practices and 5 control practices). Intervention: A quality system with five components: identification of barriers, documentation, education, feedback, and peer review. Patients: Outpatients 16 to 70 years of age with asthma or chronic obstructive pulmonary disease. Measurements: The number of consultations for respiratory symptom monitoring, measurement of peak expiratory flow rate, prescription of anti-inflammatory agents, monitoring of medication compliance and inhalation technique, and influenza vaccination. Results: The percentage of patients who had two or more consultations per year increased significantly in the intervention practices (median, 27% of patients before the intervention vs 82% of patients after the intervention; P < 0.01), as did the percentage of patients who had at least one measurement of peak expiratory flow rate (median, 10% of patients before the intervention vs 84% of patients after the intervention; P < 0.01). The percentage of patients who received a prescription for anti-inflammatory agents did not increase significantly. No significant changes were seen in the control practices. Physicians in the intervention practices were more likely to monitor medication compliance and inhalation technique. No difference was found in frequency of influenza vaccination. Conclusion: The quality system improved guideline compliance in some areas but not in others. (aut. ref.