Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States
Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States
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DOI：
10.1001/jamanetworkopen.2020.10511
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发表时间：
2020-07-15
影响因子：
13.8
通讯作者：
Arbes, Samuel J., Jr.
中科院分区：
文献类型：
--
作者：
Gupta, Ruchi S.;Bilaver, Lucy A.;Arbes, Samuel J., Jr.
2017年美国预防花生过敏补充指南建议儿科医生评估婴儿花生过敏风险，并在4至6个月时将花生引入饮食中。早期引入有可能预防花生过敏的发展。目的衡量美国儿科医生对指南的认知率和执行率，并确定实施指南的障碍和相关因素。这项基于人群的研究调查使用了一项29项的电子调查工具，于2018年6月1日至2018年12月1日期间对全美执业的儿科医生进行了调查。美国儿科学会供应商数据库中的所有儿科医生都收到了完成调查的邀请。符合条件的参与者是为12个月或更小的婴儿提供一般护理的美国非退休儿科医生。主要结果和措施主要结果是指南实施的普遍程度，这是通过一个关于意识的调查项目和第二个关于实施的调查项目来衡量的。次要结果包括确定儿科医生提供的以指南为重点的服务、指南的知识（用3个临床情景来衡量）、指南实施的障碍、培训需求和指南实施的促进因素。结果共有1781名儿科医生符合条件参与并完成了整个调查。大多数受访者自认为是白人（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%）儿科医生报告了解该指南。在了解指南的儿科医生中，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。常见的实施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%]），以及进行办公室监督喂养（509名受访者报告[32.4%;95% CI, 30.1%-34.8%]）。许多儿科医生（1175名[68.4%;95% CI, 66.1%-70.5%]）报告需要进一步接受指南培训。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表示全面实施了指南。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，从而减少婴儿花生过敏的发生率。目前美国《2017年预防花生过敏补充指南》的实施率是多少？在为12个月或以下婴儿提供护理的儿科医生中，实施指南的障碍是什么？在本研究对1781名美国儿科医生的调查中，93%的受访者了解该指南。在那些了解指南的人中，29%的人完全实施了指南，64%的人部分实施了指南。这些发现表明，了解儿科医生的实施障碍和需求对于提高依从性和减少婴儿花生过敏发生率是必要的。这项调查研究描述了在照顾婴儿的儿科医生中，自我报告的依从性、熟悉度和实施需要与国家花生过敏预防建议相关的水平。
Importance 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. Objectives 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. Main Outcomes and Measures 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. Results 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. Conclusions and Relevance 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.Question What is the current rate of implementation of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States, and what are the barriers to implementation among pediatricians who provide care for infants aged 12 months or younger? Findings In this study survey of 1781 US pediatricians, 93% of respondents were aware of the guideline. Of those who had knowledge of the guidelines, 29% were fully implementing them and 64% were partially implementing them. Meaning These findings suggest that understanding implementation barriers and needs among pediatricians is necessary to increase adherence and reduce peanut allergy incidence in infants.This survey study describes the self-reported level of adherence, familiarity, and implementation needs associated with national peanut allergy prevention recommendations among pediatricians caring for infants.