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Infantile Gastroesophageal Reflux: Adherence to Treatment Guidelines in the Hospital Setting
Insights
Infants with gastroesophageal reflux (GER) are still receiving acid suppression therapy in hospitals, despite guidelines recommending against it. This study surveyed pharmacists, revealing continued non-adherence to best practices for infantile GER management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacy Practice
- Evidence-Based Medicine
Background:
- Recent guidelines differentiate management of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).
- Current recommendations advise against empiric acid suppression therapy for infantile GER.
- Assessing adherence to these guidelines in clinical practice is crucial.
Purpose of the Study:
- To evaluate inpatient guideline adherence for infantile GER management from pharmacists' perspectives.
- To assess pharmacists' comfort in distinguishing GER from GERD.
- To identify current practice trends and institutional guideline availability for infantile GER.
Main Methods:
- A national online survey was distributed to pharmacists with inpatient pediatric experience.
- The 2009 NASPGHAN/ESPGHAN Pediatric Gastroesophageal Reflux Clinical Practice Guideline informed survey development.
- Data collected included pharmacist demographics and institutional characteristics.
Main Results:
- The survey achieved a 14.8% response rate (n=149).
- While 29.7% reported no empiric acid suppression for infantile GER, 44.6% initiated these trials 1-2 times/week, and 19.6% initiated them 3-5 times/week.
- A notable percentage of pharmacists reported even higher frequencies of empiric trials.
Conclusions:
- Infants in inpatient settings continue to receive empiric acid suppression trials for GER.
- This practice demonstrates a lack of adherence to current guideline recommendations.
- Further interventions may be needed to align practice with evidence-based guidelines.
Objectives:
Recent guidelines defined and differentiated the management of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). The guidelines recommend against using empiric acid suppression therapy for infantile GER. The primary objective of this study was to assess inpatient guideline adherence regarding management of infantile GER through the perspective of pharmacists. Secondary objectives included assessing pharmacist comfort level with differentiation between GER and GERD, observing current trends in practice relating to the primary objective, and determining the availability of institution-specific guidelines that address the management of infantile GER.
Methods:
An institutional review board-approved, national, online survey of pharmacists with inpatient pediatric experience was conducted. Pediatric pharmacy membership directories were used to create the listserv of eligible pharmacists. The 2009 NASPGHAN/ESPGHAN (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Gastroenterology, Hepatology, and Nutrition) Pediatric Gastroesophageal Reflux Clinical Practice Guideline was used to develop the survey and to define both GER and GERD. Demographic data was also collected regarding the institutional setting and pharmacists responding.
Results:
The overall response rate was 14.8% (n = 149). Although 29.7% of pharmacists stated empiric acid suppression trials were not used for infantile GER at their institution, 44.6% responded that these trials are initiated 1 to 2 times per week in their hospitals. In addition, 19.6% responded that these empiric trials were initiated 3 to 5 times per week. A smaller percentage of responders reported even higher frequencies per week at their institutions.
Conclusions:
From the results of the survey, infants continue to receive empiric acid suppression trials for GER in the inpatient setting, which is not adherent to the current guideline recommendation.
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