Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics.
J Pediatr Gastroenterol Nutr. 2018 Nov;67(5):605-609. doi: 10.1097/MPG.0000000000002054.
Acid-suppressant prescriptions for children have increased over past decades, despite guideline recommendations to prescribe prudently. Acid suppressants are often ineffective and may lead to side effects. We aimed to reduce inappropriate acid-suppressant prescriptions for gastroesophageal reflux in a tertiary care setting through active implementation of national guideline recommendations and to evaluate intervention effect.
Implementation consisted of 2 steps. First, all pediatric clinicians in an academic hospital received information on appropriate acid-suppressant prescribing, a link to an online national guideline application and summary card with important evidence-based recommendations-Wise Choices. Hereafter, clinicians prescribing acid suppressants were contacted to provide feedback on indications and to assess their knowledge of the guideline and Wise Choices. The pharmacy database supplied prescription data before, during, and after this intervention.
During the study period prescriptions ranged from 115 to 201/month. Ten months postintervention, a nonsignificant decrease of 4 prescriptions/month was measured (95% confidence interval -49-41). Of the 78 prescribers 76 were successfully contacted: 63% were familiar with the guideline and 45% with Wise Choices. Thirty percent of prescriptions were for gastroesophageal reflux symptoms.
This multifaceted implementation strategy did not lead to a significant difference in acid-suppressant prescriptions by tertiary care clinicians of whom the majority was familiar with the gastroesophageal reflux disease guideline. Future studies should clarify, which implementation strategies are most effective in reducing inappropriate prescribing of acid suppressants for children. Uniform registration of prescriptions and indications in a national database will enable monitoring of the intervention effect.
尽管指南建议谨慎处方，但过去几十年来，儿童的抑酸剂处方量有所增加。抑酸剂通常无效，并且可能导致副作用。我们旨在通过积极实施国家指南建议，减少三级保健环境中胃食管反流病的不当抑酸剂处方，并评估干预效果。
实施包括 2 个步骤。首先，学术医院的所有儿科临床医生都收到了关于适当抑酸剂处方的信息，包括在线国家指南应用程序的链接和带有重要循证建议的明智选择摘要卡。此后，为开具抑酸剂的临床医生提供反馈，评估他们对指南和明智选择的了解情况。药房数据库在干预前后提供处方数据。
在研究期间，处方量从每月 115 至 201 张。干预后 10 个月，每月处方量下降了 4 张，但无统计学意义（95%置信区间-49-41）。在 78 名开处方者中，成功联系了 76 名：63%的人熟悉该指南，45%的人熟悉明智选择。30%的处方用于胃食管反流症状。
这种多方面的实施策略并未导致三级保健临床医生开具抑酸剂的处方数量显著减少，而大多数临床医生都熟悉胃食管反流病指南。未来的研究应阐明哪些实施策略最能有效减少儿童不当使用抑酸剂的情况。在国家数据库中统一登记处方和适应症将能够监测干预效果。
