A qualitative evaluation of pediatric conjunctivitis medical decision making and opportunities to improve care.
A qualitative evaluation of pediatric conjunctivitis medical decision making and opportunities to improve care.
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DOI：
10.1016/j.jaapos.2021.12.008
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发表时间：
2022-06
期刊：
影响因子：
1.6
通讯作者：
Frost, Holly M.
中科院分区：
文献类型：
--
作者：
Sebastian, Thresia;Frost, Holly M.
急性感染性结膜炎是一种常见的儿童疾病，抗生素治疗的作用仍不清楚。本研究的目的是描述提供者在管理传染性结膜炎时使用的决策过程，以确定减少不必要的抗生素处方的因素，并评估 COVID-19 大流行如何影响处方行为。我们对科罗拉多州丹佛市的 20 家在初级护理、紧急护理和急诊部门照顾儿童的提供者进行了半结构化访谈。使用演绎和归纳内容分析方法对访谈的主要主题进行评估。决定用抗生素治疗传染性结膜炎的重要驱动因素包括患者的临床表现、家庭期望、抗生素管理问题、病因诊断的不确定性以及学校/日托政策。用于区分病毒性结膜炎和细菌性结膜炎的方法存在很大差异。没有提供者了解儿科治疗指南或返回学校或日托的标准化建议。医疗服务提供者报告称，在 COVID-19 大流行期间，抗生素处方量有所增加。确定的可以减少不必要的抗生素处方的因素包括家庭教育、减少诊断不确定性的可靠诊断测试、儿科临床指南以及学校/日托机构的标准化排除政策。儿童感染性结膜炎的治疗不一致。制定儿童传染性结膜炎的评估和管理指南有助于减少不必要的处方以及家庭和医疗保健系统的负担。此外，更新的学校/日托排除指南对于建立简化且基于证据的排除做法可能很重要。
Acute infectious conjunctivitis is a common childhood illness, and the role of antibiotic treatment remains unclear. The purpose of this study was to describe the decision-making process providers use when managing infectious conjunctivitis, to identify factors that reduce unnecessary antibiotic prescribing, and to evaluate how the COVID-19 pandemic influenced prescribing behavior. We conducted semi-structured interviews with 20 providers caring for children in primary care, urgent cares, and emergency departments in Denver, Colorado. Interviews were evaluated for major themes using deductive and inductive content analysis methods. Significant drivers for deciding to treat infectious conjunctivitis with antibiotics included patient’s clinical presentation, family expectations, antibiotic stewardship concerns, etiological diagnostic uncertainty, and school/daycare policies. High variability existed in approaches used to distinguish viral from bacterial conjunctivitis. No providers were aware of pediatric treatment guidelines or standardized recommendations for return to school or daycare. Providers reported higher antibiotic prescribing during the COVID-19 pandemic. Factors identified that could reduce unnecessary antibiotic prescribing included family education, a reliable diagnostic test to decrease diagnostic uncertainty, pediatric clinical guidelines, and standardizing exclusion policies for school/daycare. Management of pediatric infectious conjunctivitis is inconsistent. Creation of guidelines for the evaluation and management of infectious conjunctivitis in children could help reduce unnecessary prescribing and the burden for families and the health care system. In addition, updated guidelines for school/daycare exclusion may be important to establish streamlined and evidence-based exclusion practices.
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