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Management of acute bronchiolitis: can evidence based guidelines alter clinical practice?

J Barben1, C E Kuehni, D Trachsel

  • 1Paediatric Pulmonology, Children's Hospital, CH-9006 St Gallen, Switzerland. juerg.barben@kispisg.ch

Thorax
|August 30, 2008
PubMed

Insights

National guidelines significantly reduced bronchodilator and inhaled corticosteroid (ICS) prescriptions for infant bronchiolitis. This demonstrates the effectiveness of guideline implementation in changing pediatric treatment practices.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Health Policy

Background:

  • Acute bronchiolitis is a common infant respiratory infection with no proven drug treatments.
  • Despite this, bronchodilators and inhaled corticosteroids (ICS) were widely prescribed by Swiss pediatricians.
  • National guidelines and an implementation program were developed to address this practice.

Purpose of the Study:

  • To evaluate the impact of national guidelines and a tailored implementation program on pediatric treatment practices for acute bronchiolitis.
  • To assess changes in the prescription of bronchodilators and inhaled corticosteroids (ICS) before and after guideline implementation.

Main Methods:

  • A questionnaire survey of Swiss pediatricians was conducted in 2001 (before guidelines) and 2006 (after implementation).
  • Guidelines were developed collaboratively with pediatric pulmonologists and implemented using a multifaceted approach.
  • Response rates were 58% in 2001 (541 pediatricians) and 54% in 2006 (639 pediatricians).

Main Results:

  • Prescription rates for bronchodilators and ICS significantly decreased for both outpatients and inpatients between 2001 and 2006.
  • Outpatient bronchodilator use dropped from 60% to 23%; ICS use decreased from 34% to 6%.
  • Inpatient bronchodilator use fell from 55% to 18%; ICS use decreased from 26% to 6% (all p<0.001).

Conclusions:

  • National guidelines, coupled with a targeted implementation strategy, can substantially alter medical management practices.
  • The study highlights the successful reduction in non-evidence-based drug prescriptions for infant bronchiolitis in Switzerland.
  • This approach demonstrates a model for improving pediatric respiratory care nationwide.
Abstract

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