Effectiveness of group consensus activity in improving appropriateness of care for the management of adult asthmatic patients in the ambulatory care unit

ABSTRACT

BACKGROUND: Asthma still remains a major cause of chronic morbidity and mortality in the world. Hence it is important that quality care is given to these patients at any given time. Several methods are explored to further improve physician performance particularly residents-in-training, thus this study was conceptualized. OBJECTIVE: This study was done to determine whether a workshop allowing residents to set criteria based on a clinical practice guideline improved the appropriateness of care given to adult asthmatic patients in exacerbation as measured by chart audit. METHODS: The setting was the Ambulatory Care Unit of the Philippine General Hospital with the first year residents of the Department of Family and Community Medicine for the year 2007 as subjects. This is a "before-and-after" study. The comparison of the difference before and after workshop percentage appropriateness of care in terms of five criteria was the main outcome. RESULTS: The mean age of the first year residents was 31.57 + 4.502 years. Four were males and ten females. Mean year graduated from medical school was 5.5 + 4.47. From the five criteria, two of them history taking (93.9%) and assessment (100%) were already above the set standard of 80% prior to the workshop. After the workshop, the percentage appropriateness of care in terms of history taking and assessment was maintained above the set standard. At baseline, three of the five criteria physical examination (78.8%), treatment (51.5%) and follow-up/health education (66.7%) were noted below the set standard. The three improved after the workshop only physical examination was significant (from 78.8% to 100%, p value = 0.006), treatment improved but still below the set standard (from 51.5% to 60.6%) while follow up/health education (from 66.7% to 81.8%) was slightly above set standard. CONCLUSION: Workshop allowing the residents to have their own set of criteria based on a clinical practice guideline as an intervention for quality improvement is an effective tool in improving appropriateness of care in terms of physical examination. However, there seemed to have a need for repeated measures to further attain acceptable levels of appropriateness of care.