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Bronchiolitis guidelines: what about the Italian situation in a primary care setting?
Federica Porcaro1, Renato Cutrera2, Anna Chiara Vittucci3
1Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, piazza di Sant'Onofrio 4, Rome, 00165, Italy. federica.porcaro@opbg.net.
Insights
Primary care physicians in Italy face challenges managing acute viral bronchiolitis, leading to poor adherence to guidelines. This study explores factors influencing their prescribing of common, yet often inappropriate, medications like beta-agonists and antibiotics.
Area of Science:
- Pediatrics
- Infectious Diseases
- Primary Care Medicine
Background:
- Acute viral bronchiolitis is a leading cause of infant hospitalization.
- Its variable presentation and risk of rapid deterioration necessitate expert clinical monitoring.
- Primary care physicians (PCPs) in Italy manage initial cases, often finding them complex.
Purpose of the Study:
- To identify factors contributing to guideline non-adherence by Italian PCPs in managing acute viral bronchiolitis.
- To analyze the reasons behind the common prescription of non-recommended medications for bronchiolitis.
Main Methods:
- The study focuses on outpatient primary care settings in Italy.
- It specifically examines the prescription patterns of beta-agonists, systemic steroids, and antibiotics.
- The research investigates potential barriers to guideline adherence among PCPs.
Main Results:
- Italian studies indicate suboptimal adherence to bronchiolitis management guidelines.
- PCPs frequently prescribe medications like beta-agonists, steroids, and antibiotics.
- These prescriptions are often for conditions that mimic bronchiolitis, suggesting diagnostic challenges.
Conclusions:
- Understanding PCP challenges is crucial for improving bronchiolitis care in Italy.
- Addressing factors influencing guideline adherence can optimize treatment and reduce inappropriate medication use.
- Further research should explore targeted interventions for PCPs managing pediatric respiratory infections.
Abstract:
Acute viral bronchiolitis is the most common cause of hospitalization in children under 12 months of age. The variable clinical presentation and the potential for sudden deterioration of the clinical conditions require a close monitoring by healthcare professionals.In Italy, first access care for children is provided by primary care physicians (PCPs) who often must face to a heterogeneous disease presentation that, in some cases, make the management of patient with bronchiolitis challenging. Consequently, Italian studies report poor adherence to national and international guidelines processed to guide the clinicians in decision making in acute viral bronchiolitis.This paper aims to identify the potential factors contributing to the lack of adherence to the suggested guidelines derived by clear and evidence-based recommendations among primary care physicians operating in an outpatient setting, with a specific focus on the context of Italy. Particularly, we focus on the prescription of medications such as β2-agonists, systemic steroids, and antibiotics which are commonly prescribed by PCPs to address conditions that can mimic bronchiolitis.
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