GPs' knowledge and attitudes regarding treatment of UTI and asthma in Sweden: A randomised controlled educational trial on guideline implementation

Abstract

Background: Guidelines need effective means of implementation. An educational model was developed, aiming at improving treatment through guideline implementation in primary care. As knowledge of and attitudes in accordance with guideline content is one important piece in implementation, the model developed was evaluated regarding these issues. Methods: Thirty-six general practitioner (GP) groups (204 GPs) participated in this Swedish study, which was carried out within The European Drug Education Project. Each group was randomised to education on treatment of uncomplicated urinary tract infection (UTI) or asthma (parallel study arms which acted as controls for each other). The education comprised outreach visits to each group in which individual feedback was discussed and related to the guidelines. A questionnaire on knowledge and attitudes related to the guidelines (44 items) was completed individually before and after the education. Analysis of aggregated data on single items and multilevel analysis of sum scores per GP were used to assess intervention effects. Results: For drug choice in UTI, the increase in agreement with the guidelines was significant, 31 percentage points in the intervention arm compared to three in the control arm (p=0.028). For asthma, knowledge was already high (>90% correct responses) for many items, e.g. concerning the use of inhaled corticosteroids, before the intervention with no significant intervention effects. A significant time trend (p<0.03) was seen for sum scores of knowledge for both UTI and asthma. The response rate was 88% before and 77% after the intervention. Conclusion: An improvement in knowledge of first-choice antibiotics for UTI was seen using the educational model developed.