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Implementation of evidence-based management of acute bronchiolitis
J U Barben1, C F Robertson, P J Robinson
1Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Australian paediatricians frequently use unproven pharmaceutical agents for acute viral bronchiolitis (AVB) despite guidelines. More strategies are needed to ensure appropriate AVB management for children.
Area of Science:
- Pediatrics
- Clinical Practice Guidelines
- Respiratory Medicine
Background:
- Clinical guideline implementation often lags behind evidence dissemination.
- Australian guidelines for acute viral bronchiolitis (AVB) management have been recently published.
- Assessing current paediatrician practices is crucial for guideline implementation.
Purpose of the Study:
- To evaluate the current practice of Australian paediatricians in managing acute viral bronchiolitis (AVB).
- To identify variations in AVB management and adherence to guidelines.
Main Methods:
- A questionnaire survey was distributed to all Australian paediatricians.
- A comprehensive review of the existing literature on AVB management was conducted.
Main Results:
- A 62% response rate was achieved from 891 paediatricians surveyed.
- Significant variation in AVB management practices was observed among respondents.
- Despite lack of evidence, pharmaceutical agents were frequently used in AVB management (70% outpatient, 88% inpatient).
Conclusions:
- Pharmaceutical agents are commonly used in AVB management by Australian paediatricians, contrary to guidelines and evidence.
- Current Australian practices show less frequent use of bronchodilators and corticosteroids compared to European surveys.
- Guidelines alone are insufficient; targeted strategies are necessary for effective AVB management in children.
Objective:
Implementation of clinical guidelines is frequently delayed well beyond their dissemination and the publication of clinical evidence. The recently published Australian guidelines for the management of acute viral bronchiolitis (AVB) have been evaluated by assessing the current practice of Australian paediatricians.
Methods:
Questionnaire survey of all Australian paediatricians and a review of the literature.
Results:
Of a total of 891 questionnaires, 555 (62%) were returned. Of the respondents, 373 (67%) treated children with AVB and, of these, 232 (67%) treated 10-50 children per year. A wide variation in management practice for both outpatient and inpatient treatment of AVB was identified. Up to 70% of paediatricians who treated AVB indicated using pharmaceutical agents in their outpatient management (88% in inpatient management), most using these agents 'sometimes' or in high-risk children. Paediatric respiratory physicians tended to use bronchodilators less frequently than general paediatricians. Compared with many countries in Europe, few Australian paediatricians routinely use supplementary drugs in the inpatient managenment of AVB; in particular, bronchodilators (61 vs 7%) and corticosteroids (11 vs 1%) are used far less often. A review of the literature demonstrated that pharmaceutical agents do not influence the course of AVB.
Conclusions:
Despite a lack of evidence for their efficacy and the recommendation of the Australian guidelines, pharmaceutical agents are frequently used in the management of AVB by paediatricians in Australia, although far less than reported in a recently published European survey. Guidelines alone are not sufficient to implement change and there is a need for more specific strategies to ensure that children receive appropriate management for this common condition.