Variability in malaria prophylaxis prescribing across Europe: A Delphi method analysis
Variability in malaria prophylaxis prescribing across Europe: A Delphi method analysis
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DOI：
10.1111/j.1708-8305.2008.00226.x
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发表时间：
2008-09-01
影响因子：
25.7
通讯作者：
Caramello, Pietro
中科院分区：
文献类型：
--
作者：
Calleri, Guido;Behrens, Ron H.;Caramello, Pietro
背景处方疟疾化学预防的适应症缺乏坚实的证据基础，导致主观性和各国和专业人员之间的实践差异很大。欧洲旅行医学专家是TropNetEurope的成员，他们参加了一项使用德尔菲方法进行的调查。这种技术有助于通过反复的问卷调查、控制主导的反馈和统计组的响应来评估和发展共识。第一份调查问卷，包括关于疟疾预防处方中有争议的问题，要求在1到10之间的视觉量表上回答。调查问卷包括有问题的处方，药物的特点，地理的相关性，以及昆虫叮咬预防的重要性。第一轮小组答复的重复调查表显示，对大多数问题的共识越来越多。第二项调查考虑了14种实际情况（包括两种内部标准），并调查了首选的预防措施。在1.4个情景中，有8个情景达成了重大共识，第二轮后没有增加。分析显示，处方选择与偏好按执业区域分组的差异很大，并且在北方和南欧比在中欧更愿意开处方。第二轮调查显示，9.5%的人改变了看法。该研究表明，需要改善疟疾药物预防处方的有效性、耐受性和风险的证据基础，并在整个欧洲进行进一步讨论，以实现处方实践的协调。
Background. The indications for prescribing malaria chemoprophylaxis lack a solid evidence base that results in subjectivity and wide variation of practice across countries and among professionals.Methods. European experts in travel medicine, who are members of TropNetEurop, participated in a survey conducted using the Delphi method. This technique alms at evaluating and developing a consensus through iterations of questionnaires, control led feedback, and statistical group responses.Results. A first questionnaire, including questions about controversial issues in prescribing malaria prophylaxis, required responses on a visual scale between 1 and 10. The questionnaire included issues on problematic prescribing, characteristics of drugs, relevance of geography, and importance of insect bite prevention. The repeat questionnaire with the group response from the first round revealed an increasing consensus on most issues. A second survey considered 14 practical scenarios (including two internal standards) and investigated preferred choice of prophylaxis. As significant consensus was noted in 8 of 1.4 scenarios, which did not increase after a second round. The analysis revealed a wide variation in prescribing choices with preferences grouped by region of practice, and a greater willingness to prescribe in northern and southern Europe than in central Europe. The second round showed a 9.5% change of opinion.Conclusions. The Study shows that improving the evidence base on efficacy and tolerability and risk of malaria for prescribing chemoprophylaxis is needed as is further discussion across Europe to achieve harmonization of prescribing practice.