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Management of bronchiolitis in Portugal, 2000-2015: Do guidelines have an impact?
José Fontoura-Matias1, Diana Moreira-Sousa2, Alberto Freitas3,4
1Department of Pediatrics, Hospital São João, Porto, Portugal.
Insights
Overuse of diagnostic and treatment procedures for bronchiolitis in children remains high, despite a modest decrease over time. Regional variations are significant, indicating a need for improved guideline implementation.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Bronchiolitis management often involves diagnostic tests and treatments not supported by clinical guidelines.
- Excessive utilization of these interventions raises concerns about patient care and healthcare costs.
Purpose of the Study:
- To evaluate medical interventions for hospitalized children with bronchiolitis in Portuguese public hospitals (2000-2015).
- To assess the impact of a national guideline on bronchiolitis management published in December 2012.
- To analyze regional variations in the application of diagnostic and treatment procedures.
Main Methods:
- Retrospective analysis of an administrative database covering all hospitalizations in mainland public hospitals.
- Inclusion criteria: children under 2 years old with ICD-9-CM codes for bronchiolitis (466.11, 466.19).
- Statistical analysis using chi-squared test and logistic regression.
Main Results:
- Analysis of 80,491 hospitalizations revealed high rates of nonrecommended procedures: chest x-ray (66.5%), blood tests (56.5%), nebulized therapy (83.5%), IV corticosteroids (24.2%), and IV antibiotics (26.0%).
- A modest decreasing trend in the use of nonrecommended procedures was observed over time (P < .001).
- Significant regional variations in procedure rates were noted, with the Center region showing the lowest rates.
Conclusions:
- Despite a slight downward trend, nonrecommended diagnostic and treatment practices for bronchiolitis remain prevalent in Portugal.
- The national guideline showed no clear impact on changing clinical attitudes.
- Regional disparities and the persistent overuse highlight the need for more active strategies to improve guideline adherence.
Background:
Several studies report an excessive use of diagnostic tests and procedures in bronchiolitis, not supported by guidelines.
Objectives:
We aimed to evaluate medical interventions in children hospitalized with bronchiolitis in public Portuguese hospitals, from 2000 to 2015, to evaluate the impact of the national guideline, published in December 2012, and assess variations between regions.
Methods:
Data was collected retrospectively from an administrative database that contains all hospitalizations in mainland public hospitals. Cases were selected using the ICD-9-CM codes 466.11 (bronchiolitis due to respiratory syncytial virus) and 466.19 (bronchiolitis due to other infectious organisms), in children under 2 years of age. For statistical analysis we used the χ2 test and logistic regression.
Results:
In the 80 491 hospitalizations due to bronchiolitis, we found a high mean use rate of nonrecommended diagnostic and treatment procedures: chest x-ray (66.5%), blood analysis (56.5%) and respiratory secretions analysis (12.7%); nebulized therapy (83.5%), intravenous (IV) corticosteroids (24.2%), IV antibiotics (26.0%), electrolytes infusion (37.6%), and chest physiotherapy (20.4%). Over time, there was a gradual change in attitudes (Ptrend < .001), with significant variation between regions. Center region registered the lowest mean rates of routinely nonrecommended procedures.
Conclusions:
In this first national study, rates of the nonrecommended diagnostic and treatment attitudes in bronchiolitis were higher than desirable, although there was a modest decreasing trend in their use over time. The observed variations were mainly dependent on the region, with no clear impact of the national guideline in attitude changing, highlighting the need for more active measures.
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