Impact of consensus development conference guidelines on primary care of bronchiolitis: are national guidelines being followed?

Abstract

Aim: To measure the impact of French national consensus guidelines on the clinical practices of primary care paediatricians and general practitioners.

Design: Non-randomized intervention study, with a first survey 1 year before the consensus development conference and a second survey 1 year after.

Intervention: Implementation of bronchiolitis management guidelines through the medical press and the Internet.

Subjects: Paediatricians and general practitioners treating infants 1 year of age and under consulting for a first-time episode of bronchiolitis.

Results: Ninety-three doctors and 510 infants were included during the first phase of the study and 96 doctors and 394 infants during the second phase. This study showed a slight increase in adherence to the guidelines for non-validated drugs (6.6% adherence before and 14.3% after), general advice (29.0% adherence before and 57.1% after) and flow modulation respiratory physical therapy (91.9% adherence before and 98.8% after). Increase in adherence to guidelines for other practices, that is, hospitalization, prescribing antibiotics and complementary examinations, was not statistically significant. Adherence to the guidelines on providing general advice increased the most between the two studies.

Conclusion: The guidelines helped practitioners evolve slightly in their approach to the treatment of bronchiolitis. Non-validated drugs remain frequently used. Additional resources for implementing the guidelines should be provided to improve primary care doctors' practices.