rss
Evid Based Nurs 9:58 doi:10.1136/ebn.9.2.58
  • Quality improvement

Educational outreach visits to primary care nurses improved tuberculosis detection and treatment of obstructive lung disease


 
 Q Do educational outreach visits to nurse practitioners improve tuberculosis detection and management of respiratory illness in primary care clinics in rural South Africa?

METHODS

GraphicDesign:

cluster randomised controlled trial.

GraphicAllocation:

concealed.

GraphicBlinding:

blinded (patients and data collectors).

GraphicFollow up period:

1 and 4 months after intervention began.

GraphicSetting:

40 large primary care clinics in Free State province, South Africa.

GraphicPatients:

1999 patients ⩾15 years of age (mean age 45 y, 65% women) who had difficult breathing on presentation or in the past 6 months, current cough for ⩾7 days, recurrent cough in the past 6 months, or current cough with temperature >38°C or respiratory rate ⩾30 breaths/minute. Patients referred elsewhere for urgent treatment were excluded.

GraphicIntervention:

20 clinics (1000 patients) were allocated to educational outreach visits for nurse practitioners. Specially trained nurse supervisors conducted educational sessions at the clinics (median 2 per clinic over 3 mo, 1–3 h each) on integrated case management of priority respiratory infections, based on an algorithmic guideline using symptoms and simple signs for diagnosis and management of respiratory diseases in adults. 20 clinics (999 patients) were allocated to no new training.

GraphicOutcomes:

included sputum screening for tuberculosis (patient report), case detection of tuberculosis (patient report or tuberculosis card), inhaled corticosteroid prescriptions for obstructive lung disease, and antibiotic prescriptions for respiratory tract infections.

GraphicPatient follow up:

93% (100% included in intention to treat analysis. It was assumed that no outcomes occurred in patients lost to follow up.)

MAIN RESULTS

At 4 months, rates of sputum screening for tuberculosis and antibiotic prescriptions for respiratory illness did not differ in outreach and control clinics; however, tuberculosis case detection rates were higher in outreach clinics, and more patients received inhaled corticosteroids for obstructive lung disease (table).

CONCLUSION

Educational outreach visits to nurses in primary care clinics increased rates of tuberculosis detection and inhaled corticosteroid prescriptions for obstructive lung disease.

Commentary

  1. Judith Carrier, RGN, MSc
  1. School of Nursing and Midwifery Studies, Cardiff University, Caerleon, South Wales, UK

      Although educational outreach is an effective method of improving the practice of healthcare professionals, especially prescribing practices, its cost effectiveness remains unclear.1 The study by Fairall et al showed that educational outreach improved tuberculosis case detection and treatment of asthma by nurse practitioners working in South African primary care clinics. An algorithmic guideline was developed for diagnosis and management of respiratory diseases, and key messages from the guidelines were delivered to practitioners during interactive educational outreach sessions. Although the general message of the study—that educational outreach can positively enhance patient care—is an important one, the findings are not necessarily generalisable to other populations with respiratory illness. Guidelines for diagnosis and management of asthma and chronic obstructive pulmonary disease in other countries2,4 are often subject to far more stringent criteria than those presented in the key messages. The study by Fairall et al confirms current recommendations that guidelines plus dissemination or implementation strategies are generally effective in improving patient care provided by professions allied to medicine.5

      References

      Educational outreach for nurses v no new training (control) for detection and management of respiratory illness in primary care*

      
 
 Q Do educational outreach visits to nurse practitioners improve tuberculosis detection and management of respiratory illness in primary care clinics in rural South Africa?

      Footnotes

      • For correspondence: Dr M Zwarenstein, St Michaels Hospital, Toronto, Ontario, Canada. merrick.zwarenstein{at}ices.on.ca

      • Sources of funding: International Development Research Centre, Canada; Medical Research Council, South Africa; Free State Department of Health; and University of Cape Town Lung Institute.

      Free Sample

      This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EBN.
      View free sample issue >>

      EBN Journal Chat

      The EBN Journal Chat offers readers the opportunity to participate in discussion about research articles and commentaries from Evidence Based Nursing (EBN).

      How to participate >>

      Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

      Navigate This Article