2017年美国花生过敏预防附录指南建议儿科医生评估婴儿花生过敏风险,并在4至6个月大的饮食中引入花生。早期引入有可能防止花生过敏的发展。
评估美国儿科医生的指南认知和实施率,并确定实施的障碍和相关因素。
这项基于人群的研究调查使用了29项电子调查仪器,该仪器于2018年6月1日至2018年12月1日在美国执业的儿科医生中使用。完成调查的邀请已通过电子邮件发送给美国儿科学会供应商数据库中的所有儿科医生。符合条件的参与者是非退休的美国儿科医生,为12个月或更小的婴儿提供一般护理。
主要结果是指南实施的普遍性,这是通过一个关于意识的调查项目和第二个关于实施的项目来衡量的。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(用3种临床方案衡量),指导方针实施的障碍,需要培训,和指南实施的促进者。
共有1781名儿科医生有资格参与并完成了整个调查。大多数受访者自我认同为白人(1287[72.5%])和女性(1210[67.4%])。总的来说,1725名(93.4%;95%CI,92.2%-94.5%)儿科医生报告了解该指南。在那些了解指南的儿科医生中,497(28.9%;95%CI,26.8%-31.1%)报告全面实施,1105(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名受访者报告[36.6%;95%CI,34.3%-39.1%]),理解和正确应用指南的不确定性(521名受访者报告[33.2%;95%CI,30.9%-35.6%]),并进行办公室监督喂养(由509名受访者报告[32.4%;95%CI,30.1%-34.8%])。许多儿科医生(1175[68.4%;95%CI,66.1%-70.5%])报告需要对指南进行进一步培训。
这项调查发现,大多数儿科医生受访者似乎知道2017年的指南。但不到三分之一的受访者报告全面实施。这项研究的结果可能会为未来消除指南实施和遵守障碍的努力提供信息。从而降低婴儿花生过敏的发生率。
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.
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.