Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.
JAMA Netw Open. 2020 Jul 1;3(7):e2010511. doi: 10.1001/jamanetworkopen.2020.10511.
The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States recommend that pediatricians assess infant peanut allergy risk and introduce peanut in the diet at age 4 to 6 months. Early introduction has the potential to prevent peanut allergy development.
To measure the rates of guideline awareness and implementation and to identify barriers to and factors associated with implementation among US pediatricians.
DESIGN, SETTING, AND PARTICIPANTS: This population-based study survey used a 29-item electronic survey instrument that was administered to pediatricians practicing across the United States from June 1, 2018, to December 1, 2018. Invitations to complete a survey were emailed to all pediatricians in the American Academy of Pediatrics vendor database. Eligible participants were nonretired US-based pediatricians providing general care to infants aged 12 months or younger.
The primary outcome was the prevalence of guideline implementation, which was measured by 1 survey item about awareness followed by a second item about implementation. Secondary outcomes included identification of guidelines-focused services provided by pediatricians, knowledge of the guidelines (measured with 3 clinical scenarios), barriers to guideline implementation, need for training, and facilitators of guideline implementation.
A total of 1781 pediatricians were eligible to participate and completed the entire survey. Most respondents self-identified as white (1287 [72.5%]) and female (1210 [67.4%]) individuals. Overall, 1725 (93.4%; 95% CI, 92.2%-94.5%) pediatricians reported being aware of the guidelines. Of those pediatricians who had knowledge of the guidelines, 497 (28.9%; 95% CI, 26.8%-31.1%) reported full implementation and 1105 (64.3%; 95% CI, 62.0%-66.6%) reported partial implementation. Common barriers to implementation included parental concerns about allergic reactions (reported by 575 respondents [36.6%; 95% CI, 34.3%-39.1%]), uncertainty in understanding and correctly applying the guidelines (reported by 521 respondents [33.2%; 95% CI, 30.9%-35.6%]), and conducting in-office supervised feedings (reported by 509 respondents [32.4%; 95% CI, 30.1%-34.8%]). Many pediatricians (1175 [68.4%; 95% CI, 66.1%-70.5%]) reported a need for further training on the guidelines.
This survey found that most pediatrician respondents appeared to know of the 2017 guidelines, but less than one-third of respondents reported full implementation. Results of this study may inform future efforts to eliminate barriers to guideline implementation and adherence, thereby reducing the incidence of peanut allergy in infants.
2017 年美国预防花生过敏附加指南建议儿科医生评估婴儿患花生过敏的风险，并在 4 至 6 个月大时在饮食中引入花生。早期引入有可能预防花生过敏的发展。
衡量美国儿科医生对指南的认知和实施率，并确定实施的障碍和与实施相关的因素。
设计、地点和参与者：这项基于人群的研究使用了一份 29 项的电子调查工具，从 2018 年 6 月 1 日至 2018 年 12 月 1 日，向美国各地的儿科医生进行了调查。向美国儿科学会供应商数据库中的所有儿科医生发送了完成调查的邀请。合格的参与者是为 12 个月或以下婴儿提供一般护理的非退休美国儿科医生。
主要结果是指南实施的流行率，通过对 1 个关于意识的调查项目进行衡量，然后是 1 个关于实施的项目。次要结果包括确定儿科医生提供的以指南为重点的服务、对指南的了解（通过 3 个临床情况进行衡量）、实施指南的障碍、培训需求和实施指南的促进因素。
共有 1781 名儿科医生符合参与条件并完成了整个调查。大多数受访者自我认定为白人（1287 人[72.5%]）和女性（1210 人[67.4%]）。总体而言，1725 名（93.4%；95%CI，92.2%-94.5%）儿科医生表示了解这些指南。在了解这些指南的儿科医生中，497 名（28.9%；95%CI，26.8%-31.1%）报告完全实施，1105 名（64.3%；95%CI，62.0%-66.6%）报告部分实施。实施的常见障碍包括父母对过敏反应的担忧（575 名受访者[36.6%；95%CI，34.3%-39.1%]）、对理解和正确应用指南的不确定性（521 名受访者[33.2%；95%CI，30.9%-35.6%]）和进行办公室监督喂养（509 名受访者[32.4%；95%CI，30.1%-34.8%]）。许多儿科医生（1175 人[68.4%；95%CI，66.1%-70.5%]）报告说需要进一步培训这些指南。
这项调查发现，大多数儿科医生受访者似乎都知道 2017 年的指南，但不到三分之一的受访者报告完全实施。这项研究的结果可能为未来消除指南实施和遵守的障碍提供信息，从而降低婴儿花生过敏的发生率。
