Study ID | Clinical process | Patient population | Effects of practice size |
---|---|---|---|
Use of diagnostic tests | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Diagnosis by spirometry or peak flow | Asthma | No effect |
Recording of symptoms | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Asked about difficulty with sleeping, day symptoms, and interference with daily activities | Asthma | No effect |
Recording of risk factors | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Presence of suicidal thoughts | Depression | No effect |
Majeed et al, 200325 | Blood pressure, body mass index, and cholesterol | IHD | No effect |
Medication prescription | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Oral pharmacological therapy, NSAID, and oral agent | Osteoarthritis | No effect |
Antidepressant | Depression | No effect | |
Majeed et al, 200325 | Aspirin, statin, angiotensin-converting enzyme inhibitor, and beta-blocker | IHD | No effect |
Patient education | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Natural history, treatment, self-management, and medication risks | Osteoarthritis | No effect |
Specialist referrals | Large practices (RR per unit increase in number of partners = 1.11; 95% CI = 1.07 to 1.16, P<0.001) | ||
Hugo et al, 200023 | Referral rate for eating disorder | <65 years | |
Timely review | |||
Abdelhamid et al, 2010/Broadbent et al, 2008/Vedavanam et al, 200917–19 | Regular assessment of functional status and pain | Osteoarthritis | No effect |
Review in last 15 months; predicted peak flow calculated and inhaler technique checked in last 5 years | Asthma | No effect | |
Offer of follow-up appointment within 4 weeks of first treatment | Depression | Large practices (OR = 0.93; 95% CI = 0.55 to 1.54) | |
Adherence to clinical practice guidelines | |||
Rushton et al, 200429 | Incorporation of American Academy of Paediatric guidelines | ADHD | Large practices (OR = 2.0; 95% CI = 1.11 to 3.33) |
Preventive services | |||
Bower et al, 2003/Campbell et al, 200115,16 | Childhood immunisation, preschool booster, MMR booster and vaccine | Children | No effect |
Cervical cytology | General | No effect | |
Hippisley-Cox et al, 200122 | Immunisation and preschool booster | Children | No effect |
Cytology | General | Large practices (OR = 3.23; 95% CI = 1.19 to 9.09, P = 0.02) | |
Thalanany and Derrough, 200527 | Pneumococcal vaccination | ≥80 years | Large practices (OR = 1.45; P<0.0001) |
Pham et al, 200528 | Influenza, pneumococcal vaccinations | ≥65 years | No effect |
Colonoscopy/sigmoidoscopy | 65–79 years | No effect | |
Mammography | 65–74 years | Large practices (OR = 1.40; 95% CI = 1.10 to 1.77) | |
Haemoglobin A1c testing | ≥65 years diagnosed with diabetes | Large practices (OR = 1.91; 95% CI = 1.40 to 2.60) | |
Diabetic eye examinations | ≥65 years diagnosed with diabetes | No effect | |
de Koning et al, 200531 | Suboptimal preventive care preceding occurrence of stroke | Stroke | No effect |
Wenghofer et al, 200930 | Well care and health maintenance | General | No effect |
Management of diseases | |||
Bower et al, 2003/Campbell et al, 200115,16 | Disease management | Angina and asthma | No effect |
Disease management | Diabetes | Large practices (regression coefficient for number of employed staff = 0.54; 95% CI = 0.12 to 0.96, P = 0.014) | |
Wenghofer et al, 200930 | Managing patients with chronic and acute conditions, and new presentations | General | No effect |
ADHD = attention deficit hyperactivity disorder. IHD = ischaemic heart disease. NSAID = non-steroidal anti-inflammatory drug. OR = odds ratio. RR = rate ratio.