The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .
Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America—Cluster Randomized Controlled Trial
High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America . Very few interventions targeting general practitioners ( GPs ) to decrease inappropriate antibiotic prescribing have been investigated in this region . This study assessed the effectiveness of online feedback on reducing antibiotic prescribing in patients with suspected respiratory tract infections ( RTIs ) attending primary care . The aim was to reduce antibiotic prescribing in patients with acute bronchitis and acute otitis media . Both are RTIs for which antibiotics have a very limited effect . A cluster r and omized two-arm control trial was implemented . Healthcare centres from Bolivia , Argentina , Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were r and omly allocated to either intervention or control group . During ten consecutive weeks , GPs in the intervention group received evidence -based online feedback on the management of suspected RTIs . In patients with acute bronchitis , the intervention reduced the antibiotic prescribing rate from 71.6 % to 56 % ( control group from 61.2 % to 52 % ) . In patients with acute otitis media , the intervention reduced the antibiotic prescribing from 94.8 % to 86.2 % ( no change in the control group ) . In all RTIs , the intervention reduced antibiotic prescribing rate from 37.4 % to 28.1 % ( control group from 29 % to 27.2 % ) . Online evidence -based feedback is effective for reducing antibiotic prescribing in patients with RTIs attending primary care in South America
The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .