Brière Raphaëlle, Benhamed Axel, Émond Marcel, Blanchard Pierre-Gilles, Drolet Sébastien
Département de Chirurgie, CHU de Québec, Université Laval, Quebec, QC, Canada.
Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France.
CJEM. 2023 Dec;25(12):968-975. doi: 10.1007/s43678-023-00606-y. Epub 2023 Oct 20.
International guidelines now recommend nonantibiotic treatment of uncomplicated diverticulitis. We assessed physicians' current management strategies for uncomplicated diverticulitis, their awareness of the updated recommendations, and barriers to practice change.
A 21-question web-based survey conducted between 09/2022 and 11/2022 was sent to participants through their respective Quebec provincial associations or working groups. Participants included general surgeons, emergency physicians, gastroenterologists and general practitioners. Physicians who did not treat diverticulitis were excluded. The main outcomes were awareness of guideline recommendations on uncomplicated diverticulitis treatment, the use of nonantibiotic management for uncomplicated diverticulitis and identification of perceived barriers to practice change.
The participation rate was 15.9%. The 465 participants consisted primarily of general practitioners (41.7%), general surgeons (29.2%) and emergency physicians (17.8%). Eighty-two percent had heard of the nonantibiotic treatment strategy for uncomplicated diverticulitis; 7.5% were "uncomfortable" and 44.6% "somewhat uncomfortable" with this practice. A third (31.8%) of all physicians had no knowledge of the updated guidelines on uncomplicated diverticulitis treatment. Most reported "never" (41.6%) or "rarely" (25.1%) omitting antibiotics for uncomplicated diverticulitis. When informed about nonantibiotic treatment, 28.7% and 51.4% of all physicians, respectively, indicated that this "will" change or "may" change their practice. Common perceived barriers to nonantibiotic treatment were concerns about treatment failure (69.6%), unawareness of updated recommendations (67.0%), difficulty in ensuring proper follow-up (59.0%) and workplace culture (54.9%).
Physicians' awareness of practice guidelines recommending nonantibiotic treatment for uncomplicated diverticulitis and their application are suboptimal. Knowledge transfer activities, educational interventions and optimization of local protocols are needed to ensure the rational use of antibiotics.
国际指南现推荐对单纯性憩室炎进行非抗生素治疗。我们评估了医生对单纯性憩室炎的当前管理策略、他们对更新后推荐意见的知晓情况以及实践改变的障碍。
2022年9月至2022年11月期间通过各自的魁北克省级协会或工作组向参与者发送了一份包含21个问题的网络调查问卷。参与者包括普通外科医生、急诊医生、胃肠病学家和全科医生。不治疗憩室炎的医生被排除。主要结果是对单纯性憩室炎治疗指南推荐意见的知晓情况、对单纯性憩室炎采用非抗生素管理的情况以及识别出的实践改变的感知障碍。
参与率为15.9%。465名参与者主要包括全科医生（41.7%）、普通外科医生（29.2%）和急诊医生（17.8%）。82%的人听说过对单纯性憩室炎的非抗生素治疗策略；7.5%的人对此做法“不舒服”，44.6%的人“有点不舒服”。所有医生中有三分之一（31.8%）不了解单纯性憩室炎治疗的更新指南。大多数人报告在治疗单纯性憩室炎时“从不”（41.6%）或“很少”（25.1%）省略使用抗生素。当被告知非抗生素治疗时，所有医生中分别有28.7%和51.4%表示这“会”改变或“可能”改变他们的做法。非抗生素治疗常见的感知障碍包括对治疗失败的担忧（69.6%）、不了解更新后的推荐意见（67.0%）、难以确保适当的随访（59.0%）和工作场所文化（54.9%）。
医生对推荐对单纯性憩室炎进行非抗生素治疗的实践指南的知晓情况及其应用并不理想。需要开展知识传播活动、教育干预和优化当地方案，以确保抗生素的合理使用。
