Results of PAL feasibility test in primary health care facilities in four regions of Bolivia.

SETTING: Primary health care (PHC) centres in four Bolivian regions. OBJECTIVES: To test the feasibility and impact of training general practitioners (GPs) in standard case management of respiratory conditions in patients aged > or =5 years. DESIGN: Comparison of the results of two surveys: the baseline survey before training and the impact survey after training on standard guidelines on case management of respiratory conditions. RESULTS: A total of 78 GPs working in 65 health centres participated in both surveys. The baseline survey registered 1033 respiratory patients and the impact survey 1154. The patients were comparable in sex distribution, previous visits, duration of symptoms and clinical diagnoses. The differences were significant in age distribution, concomitant diseases and risk factors. As a result of training, referrals to a higher level decreased by 34.6% and the proportion of tuberculosis (TB) suspects identified increased by 30%. The number of drugs prescribed per patient decreased by 16.2%. The average cost of prescription of any drug per patient dropped by 32.3%. CONCLUSION: Training in the standard practical approach to lung health guidelines improved the quality and reduced the cost of treatment of respiratory diseases at PHC units. Training should be an integral part of a comprehensive managerial approach for the implementation of case management guidelines.