[Assessment of the French Consensus Conference for Acute Viral Bronchiolitis on outpatient management: progress between 2003 and 2008].

BACKGROUND

The 2000 French Consensus Conference for Acute Viral Bronchiolitis management underlined clinical practice recommendations.

OBJECTIVE

To assess the impact of these guidelines on management of acute bronchiolitis, 3 and 8 years after publication.

METHODS

A standardized questionnaire was mailed to 762 general practitioners (GPs) in 2003 and 800 GPs in 2008. It described two clinical case scenarios (moderate acute viral bronchiolitis and severe acute bronchiolitis) and inquired about the physician's conduct in each case. The primary outcome was the percentage of responders who described patient management in accordance with current guidelines: correct diagnosis and treating the patient symptomatically in an outpatient setting in the first case and correct diagnosis in addition to requiring an inpatient setting for the second case. Secondary outcome was the percentage of responders who would have given unnecessary or potentially harmful treatments. Physician responses in 2003 and 2008 were compared using the Student t-test and the Chi(2) test. Multivariate analysis was conducted to assess the potential factors associated with good adherence to guidelines.

RESULTS

Nearly 25% of the questionnaires were returned in 2003 and 2008. Patient management was described in accordance with the guidelines in only 6% in 2003 and 20% in 2008 (p< or =0.001). Unnecessary treatments were prescribed in 77% in 2003 vs 60% in 2008 (p<0.001) and potentially dangerous treatments in 38% in 2003 vs 22 % in 2008 (p=0.006). Using multivariate analysis, the GP's age was inversely correlated with adherence to clinical recommendations (adjusted odds ratio [adOR]=0.93; 95% CI=0.87-0.98; p=0.01). Fifty-four percent of GPs reported knowing these guidelines, but only 57% of them declared that the latter has modified their practice.

DISCUSSION

GPs are still prescribing unnecessary or even potentially dangerous treatments for bronchiolitis. On the other hand, severe cases are correctly diagnosed and well managed in an inpatient setting.

CONCLUSION

Three and 8 years after their publication, adherence to guidelines is insufficient.