Intended for healthcare professionals

Primary Care

Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat

BMJ 2002; 325 doi: (Published 17 August 2002) Cite this as: BMJ 2002;325:367
  1. Signe Flottorp, researcher (signe.flottorp{at},
  2. Andrew D Oxman, directora,
  3. Kari Håvelsrud, research associatea,
  4. Shaun Treweek, researchera,
  5. Jeph Herrin, esearch analystb
  1. aDepartment of Health Services Research, Norwegian Directorate for Health and Social Welfare, PO Box 8054 Dep, N-0031 Oslo, Norway
  2. b Flying Buttress Associates, PO Box 2254, Charlottesville VA 22902, USA
  1. Correspondence to: S Flottorp
  • Accepted 24 May 2002


Objective:To assess the effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat

Design:Unblinded, cluster randomised pretest-post-test trial

Setting:142 general practices in Norway

Participants:72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throat, serving as controls for each other. 59 practices in the urinary tract infection group and 61 practices in the sore throat group completed the study. Outcomes were measured in 16 939 consultations for sore throat and 9887 consultations for urinary tract infection.

Interventions:Interventions were developed to overcome identified barriers to implementing the guidelines. The main components of the tailored interventions were patient educational material, computer based decision support and reminders, an increase in the fee for telephone consultations, and interactive courses for general practitioners and practice assistants

Main outcome measures:Changes in rates of use of antibiotics, laboratory tests, and telephone consultations

Results:Patients in the sore throat group were 3% less likely to receive antibiotics after the intervention. Women with symptoms of urinary tract infection in the intervention group were 5.1% less likely to have a laboratory test ordered. No significant differences were found between the groups for the other outcomes. Large variation was found across the included practicesin the rates of antibiotic prescription, use of laboratory tests and telephone consultations, and in the extent of change for all three outcome measures

Conclusions:Passively delivered, complex interventions targeted at identified barriers to change had little effect in changing practice


  • Funding Quality Assurance Fund of the Norwegian Medical Association and the National Institute of Public Health

  • Competing interests None declared

  • Accepted 24 May 2002
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