背景:在2019-2020年期间,细支气管炎综合护理途径(BICP)在我们的区域卫生服务(RHS)中的药物使用减少了87%。
目的:本研究旨在评估实施BICP后3年内毛细支气管炎管理变化的可持续性。
方法:一项前瞻性观察性研究,在巴斯克地区的135个初级保健(PC)中心和8个医院急诊科(ED)中,对被诊断为毛细支气管炎的儿童的处方用药率进行了研究。西班牙,在2019年至2023年的四个毛细支气管炎季节进行。在此期间,在我们的RHS中继续部署BICP相关行动。此外,制定了一项战略,以增强结果的可持续性。主要终点是服用沙丁胺醇的儿童百分比。
结果:在2019-2020年至2022-2023年的流行浪潮中,12966名婴儿在PC中被诊断为毛细支气管炎,和6676名ED婴儿。在四波中,沙丁胺醇的使用率为5.04%,10.54%,8.51%和6.05%,分别,在PC和3.36%,10.02%,ED分别为7.62%和5.77%。在四个波中,ED中其他药物的伴随给药率为3.2%,0.2%,1.0%和1.9%的肾上腺素和0.4%,0.7%,0.3%和0.4%的皮质类固醇,分别。在PC中,处方率分别为5.1%和1.8%,抗生素10.3%和4.1%,7.8%和4.5%,皮质类固醇的5.7%和2.5%,分别。
结论:通过实施我们的综合临床路径,在2019年实现的毛细支气管炎药物使用的减少在随后的三波中得到了持续。
BACKGROUND: A bronchiolitis integrated care pathway (BICP) achieved an 87% reduction in the use of medications in our regional health service (RHS) during the 2019-2020 season.
OBJECTIVE: This study aimed to assess the sustainability of the changes in bronchiolitis management over 3 years after implementation of the BICP.
METHODS: A prospective observational study on rates of medications prescribing in children diagnosed with bronchiolitis in 135 primary care (PC) centres and eight hospital emergency departments (EDs) in the Basque Country, Spain, was conducted during the four bronchiolitis seasons between 2019 and 2023. Over this period, the deployment of BICP-related actions continued in our RHS. In addition, a strategy was designed to enhance the sustainability of the results. The main endpoint was the percentage of children prescribed salbutamol.
RESULTS: Over the 2019-2020 to 2022-2023 epidemic waves, 12 966 infants were diagnosed with bronchiolitis in PC, and 6676 infants in EDs. Rates of salbutamol use over the four waves were 5.04%, 10.54%, 8.51% and 6.05%, respectively, in PC and 3.36%, 10.02%, 7.62% and 5.77% in EDs. Rates of concomitant administration of other medications in EDs over the four waves were 3.2%, 0.2%, 1.0% and 1.9% for epinephrine and 0.4%, 0.7%, 0.3% and 0.4% for corticosteroids, respectively. In PC, prescribing rates were 5.1% and 1.8%, 10.3% and 4.1% for antibiotics and 7.8% and 4.5%, 5.7% and 2.5% for corticosteroids, respectively.
CONCLUSIONS: Reductions in the use of medications for bronchiolitis achieved in 2019 through the implementation of our integrated clinical pathway have been sustained over the three subsequent waves.