Appropriate management of acute gastroenteritis in Australian children: A population-based study


Autoři: Neroli Sunderland aff001;  Johanna Westbrook aff001;  Rachel Urwin aff001;  Zoe Knights aff002;  Jonny Taitz aff003;  Helena Williams aff004;  Louise K. Wiles aff005;  Charlotte Molloy aff005;  Peter Hibbert aff005;  Hsuen P. Ting aff007;  Kate Churruca aff007;  Gaston Arnolda aff007;  Jeffrey Braithwaite aff007
Působiště autorů: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia aff001;  Emergency Department, The Children’s Hospital at Westmead, Westmead, NSW, Australia aff002;  Clinical Excellence Commission, McKell Building, Sydney, NSW, Australia aff003;  Australian Commission on Safety and Quality in Health Care, Women’s and Children’s Hospital, SALHN, Adelaide, SA, Australia aff004;  Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia aff005;  South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia aff006;  Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia aff007
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224681

Souhrn

Objectives

To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines.

Methods

Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management.

Results

A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7–50.4), 96.1% for treatment (95% CI: 94.8–97.1) and 57.6% for ongoing management (95% CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1–58.1) lower than for either ED settings (84.7%; 95% CI: 82.4–86.9) or for inpatients (84.3%; 95% CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care.

Conclusions

Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.

Klíčová slova:

Allied health care professionals – Critical care and emergency medicine – Dehydration (medicine) – Gastroenteritis – Hospitals – Inpatients – Pediatrics – Treatment guidelines


Zdroje

1. Barker SF, Zomer E, O'Toole J, Sinclair M, Gibney K, Liew D, et al. Cost of gastroenteritis in Australia: a healthcare perspective. PLoS ONE. 2018;13(4):e0195759. doi: 10.1371/journal.pone.0195759 29649285

2. Chen Y, Ford L, Hall G, Dobbins T, Kirk M. Healthcare utilization and lost productivity due to infectious gastroenteritis, results from a national cross-sectional survey Australia 2008–2009. Epidemiol Infect. 2016;144(2):241–6. doi: 10.1017/S0950268815001375 26095130

3. Davey HM, Muscatello DJ, Wood JG, Snelling TL, Ferson MJ, Macartney KK. Impact of high coverage of monovalent human rotavirus vaccine on Emergency Department presentations for rotavirus gastroenteritis. Vaccine. 2015;33(14):1726–30. doi: 10.1016/j.vaccine.2015.01.082 25681665

4. Dey A, Wang H, Menzies R, Macartney K. Changes in hospitalisations for acute gastroenteritis in Australia after the national rotavirus vaccination program. Med J Aust. 2012;197(8):453–7. doi: 10.5694/mja12.10062 23072242

5. Fonseca BK, Holdgate A, Craig JC. Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med. 2004;158(5):483–90. doi: 10.1001/archpedi.158.5.483 15123483

6. Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Med. 2007;4(3):e98. doi: 10.1371/journal.pmed.0040098 17388664

7. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, et al. European society for pediatric gastroenterology, hepatology, and nutrition/European society for pediatric infectious diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr. 2014;59(1):132–52. doi: 10.1097/MPG.0000000000000375 24739189

8. National Institute for Health and Care Excellence. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. London, UK: National Institute for Health and Care Excellence; 2009. Contract No.: Clinical guideline 84.

9. Albano F, Lo Vecchio A, Guarino A. The applicability and efficacy of guidelines for the management of acute gastroenteritis in outpatient children: a field-randomized trial on primary care pediatricians. J Pediatr. 2010;156(2):226–30. doi: 10.1016/j.jpeds.2009.07.065 19836027

10. Zolotor AJ, Randolph GD, Johnson JK, Wegner S, Edwards L, Powell C, et al. Effectiveness of a practice-based, multimodal quality improvement intervention for gastroenteritis within a Medicaid managed care network. Pediatrics. 2007;120(3):e644–50. doi: 10.1542/peds.2006-1749 17766504

11. Perlstein PH, Lichtenstein P, Cohen MB, Staat MA, Ruddy R, Kotagal UR. Changes Associated with the Introduction of an Evidence Based Clinical Practice Guideline (EBCPG) for Acute Gastroenteritis (AGE) in Children 2 Months to 5 Years of Age. Pediatr Res. 1999;45(4, Part 2 of 2):129A–A.

12. Tieder JS, Robertson A, Garrison MM. Pediatric hospital adherence to the standard of care for acute gastroenteritis. Pediatrics. 2009;124(6):e1081–7. doi: 10.1542/peds.2009-0473 19884475

13. Vecchio AL, Liguoro I, Bruzzese D, Scotto R, Parola L, Gargantini G, et al. Adherence to guidelines for management of children hospitalized for acute diarrhea. Pediatr Infect Dis J. 2014;33(11):1103–8. doi: 10.1097/INF.0000000000000396 24830697

14. Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, et al. Quality of Health Care for Children in Australia, 2012–2013. JAMA. 2018;319(11):1113–24. doi: 10.1001/jama.2018.0162 29558552

15. Hooper TD, Hibbert PD, Mealing N, Wiles LK, Jaffe A, White L, et al. CareTrack Kids-part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review. BMJ Open. 2015;5(4):e007749. doi: 10.1136/bmjopen-2015-007749 25854977

16. Wiles LK, Hooper TD, Hibbert PD, White L, Mealing N, Jaffe A, et al. CareTrack Kids-part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development. BMJ Open. 2015;5(4):e007748. doi: 10.1136/bmjopen-2015-007748 25854976

17. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. The RAND/UCLA Appropriateness Method User's Manual. Santa Monica, California, USA: RAND Corporation; 2001. Contract No.: MR-1269-DG-XII/RE.

18. Wiles LK, Hooper TD, Hibbert PD, Molloy C, White L, Jaffe A, et al. Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study. PLoS ONE. 2019;14(1):e0209637. doi: 10.1371/journal.pone.0209637 30625190

19. Korn E, Gaubard B. Confidence intervals for proportions with small expected number of positive counts estimated from survey data. Surv Methodol. 1998;24:193–201.

20. Heath I, Hippisley-Cox J, Smeeth L. Measuring performance and missing the point? BMJ (Clinical research ed). 2007;335(7629):1075–6.

21. Mathioudakis A, Rousalova I, Gagnat AA, Saad N, Hardavella G. How to keep good clinical records. Breathe (Sheff). 2016;12(4):369–73.

22. The Royal Children's Hospital Melbourne. Clinical practice guideline on gastroenteritis Melbourne, Australia. 2015 [Available from: www.rch.org.au/clinicalguide/guidelineindex/Gastroenteritis].

23. King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16):1–16. 14627948

24. Snyder JD. Use and misuse of oral therapy for diarrhea: comparison of US practices with American Academy of Pediatrics recommendations. Pediatrics. 1991;87(1):28–33. 1984614

25. Brezerra JA, Stathos TH, Duncan B, Gaines JA, Udall JN. Treatment of infants with acute diarrhoea: what's recommended and what's practiced. Pediatrics. 1992;90(1):1–4.

26. Owen J, Conway R, Silke B, O'Riordan D. Medical record documentation among interns: a prospective quality improvement study. Irish Med J. 2015;108(6):183–5.

27. Gregorio GV, Dans LF, Silvestre MA. Early versus delayed refeeding for children with acute diarrhoea. Cochrane Database Syst Rev. 2011(7):CD007296. doi: 10.1002/14651858.CD007296.pub2 21735409

28. Nicastro E, Lo Vecchio A, Liguoro I, Chmielewska A, De Bruyn C, Dolinsek J, et al. The impact of e-learning on adherence to guidelines for acute gastroenteritis: a single-arm intervention study. PLoS One. 2015;10(7):e0132213. doi: 10.1371/journal.pone.0132213 26148301

29. Fox J, Richards S, Jenkins HR, Powell C. Management of gastroenteritis over 10 years: changing culture and maintaining the change. Arch Dis Child. 2012;97(5):415–7. doi: 10.1136/archdischild-2011-300881 22362721

30. Geurts D, de Vos-Kerkhof E, Polinder S, Steyerberg E, van der Lei J, Moll H, et al. Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department. Eur J Pediatr. 2017;176(2):173–81. doi: 10.1007/s00431-016-2819-2 27933399

31. Bahm A, Freedman SB, Guan J, Guttmann A. Evaluating the impact of clinical decision tools in pediatric acute gastroenteritis: a population-based cohort study. Acad Emerg Med. 2016;23(5):599–609. doi: 10.1111/acem.12915 26824763

32. Health NSW. Infants and children: management of acue gastroenteritis. Sydney, Australia; 2014.


Článek vyšel v časopise

PLOS One


2019 Číslo 11