Management of acute bronchiolitis: can evidence based guidelines alter clinical practice?
- 1Children’s Hospital, St Gallen, Switzerland
- 2Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
- 3University Children’s Hospital Basel, Switzerland
- Dr J Barben, Paediatric Pulmonology, Children’s Hospital, CH-9006 St Gallen, Switzerland;
- Received 10 January 2008
- Accepted 22 July 2008
- Published Online First 22 August 2008
Background: Acute bronchiolitis is the most common lower respiratory tract infection in infants and there is no evidence that drug treatment alters its natural course. Despite this, most Swiss paediatricians reported in 2001 prescribing bronchodilators and inhaled corticosteroids (ICS). This situation led to the creation of national guidelines followed by a tailored implementation programme. The aim of this study was to examine if treatment practices changed after the implementation of the new guidelines.
Methods: A questionnaire on treatment of bronchiolitis was sent to all Swiss paediatricians before (2001) and after (2006) creation and implementation of national guidelines (2003–2005). Guidelines were created in collaboration with all paediatric pulmonologists and implemented carefully using a multifaceted approach.
Results: Questionnaires were returned by 541 paediatricians (58%) in 2001 and by 639 (54%) in 2006. While both surveys showed a wide variation in the treatment of bronchiolitis between physicians, reported drug prescription decreased significantly between the two surveys. For outpatients, general use (for all patients) of bronchodilators dropped from 60% to 23%, and general use of ICS from 34% to 6%. For inpatients, general use of bronchodilators and ICS dropped from 55% to 18% and from 26% to 6%, respectively (all p<0.001). The decrease was evident in all regions, among hospital and primary care physicians, and among general paediatricians and paediatric pulmonologists.
Conclusions: National guidelines together with a tailored implementation programme can have a major impact on medical management practices in a country.
Funding: CEK was supported by the Swiss National Science Foundation (PROSPER grant No 3233-069348 and 3200-069349). The mailing of the first survey was supported by an unrestricted grant of CHF 2000 from AstraZeneca. The second survey was sponsored by the Children’s Hospital St Gallen.
Competing interests: None.