BACKGROUND: Dyspepsia is among the top reasons for consults in primary care. The management for this disease entity has remained controversial. In order to resolve this issues, attempts for improving the diagnosis and treatment of dyspeptic patient should be done. Clinical practice guidelines and its active dissemination have been advocated to answer this. However. studies shown that guidelines alone led to minimal improvement in quality of care, hence the need for other strategies. This study then takes a look into the effectiveness of one such strategy, individual feedback.

OBJECTIVE: To determine whether an individualized feedback on performance improved the appropriateness of care given by residents to adult patients with dyspepsia as measured by a chart audit.

SETTING: Emergency Room Section of a tertiary hospital.

SUBJECTS: The study subjects were 1st year residents of a family medicine program for the 1999-2000.

DESIGN: Randomized controlled trial.

INTERVENTION: Individual feedback on appropriateness of care given in both written and oral form.

COMPARATIVE INTERVENTION: No feedback.

MAIN OUTCOME MEASURE: Comparison of the difference in before and after intervention percentage appropriateness of care in terms of 6 criteria between the two groups.

RESULTS: Mean age (feedback group=28.67 vs. no feedback group=29.14; p=0.6) and mean number of years graduated from medical school (feedback group=3.83 vs. no feedback group=3.28; p=0.3) were similar among the groups being compared. Baseline data shows that the residents were already giving appropriate care in terms of diagnosing adult patients with dyspepsia. However percentage appropriateness of care in all other areas measured failed to reach the 90% target standard for good quality of care. No significant differences in appropriateness of care were observed at baseline between the two groups. Post-intervention measurement of appropriateness of care increased for all criteria in the feedback group. In the no-feedback group, the trend was toward decrease. The feedback group had a 25% increase in appropriateness of therapy compared to a 2.5% decrease in the no feedback group (p=.0006). This improvement also allowed the feedback group to reach the target standard of 90% for good quality of care. The feedback group had a 10% improvement in eliciting alarm symptoms compared with absence of improvement in the no feedback group (p=0.043). In terms of appropriateness of physical examination, a 12.5% increase was seen in the feedback group compared with a 2.5% decrease in the no feedback group(p=.0128). The feedback group also showed a 15% improvement in terms of follow-up care compared with a 7% decrease in the no feedback group (p=.0084). However, in the last three criteria the improvements were not enough to reach the 90% target standard for good quality of care.

CONCLUSION: Individual feedback is an effective method in improving appropriateness of care. This method when used alone is very effective in improving appropriateness of prescribing practices. This method led to improvements in other areas of care. However, to reach target standards of performance, combining this strategy with approaches such as reminder flyers, repeated feedback might be more effective and lead to more sustained effects.

The Filipino Family Physician, 2001 39 (1) pages 1-8