Management of anaphylaxis in primary care: Canadian expert consensus recommendations
Management of anaphylaxis in primary care: Canadian expert consensus recommendations
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DOI：
10.1111/j.1398-9995.2010.02418.x
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发表时间：
2010-09-01
期刊：
影响因子：
12.4
通讯作者：
Kastner, M.
中科院分区：
文献类型：
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作者：
Waserman, S.;Chad, Z.;Kastner, M.
背景：速发过敏反应常常处理不当。我们利用对过敏反应管理差距的系统性审查的发现，为加拿大过敏专家小组评定为具有临床重要性的差距制定基于证据的建议。方法：使用名义组技术（NGT）共识方法来制定基于证据的建议初级保健中过敏反应的管理。我们的系统评价中的医生特定差距由共识会议参与者在两轮中进行优先排序，其中涉及差距的评级，讨论和重新评级。使用当前的过敏反应指南，建议，然后制定了每一类的差距，确定由小组作为临床important.Results：30个独特的医生差距的系统评价进行了分类，根据知识和过敏反应的实践行为的差距。专家组将速发型过敏反应的诊断以及何时以及如何使用肾上腺素自动注射器评定为临床重要知识差距;将肾上腺素给药不频繁或延迟、自动注射器处方率低以及反应后不频繁或不转诊至过敏专科医生评定为重要实践行为差距。证据从四个指南被用来支持的共识建议声明的三个类别的差距themes. Conclusion：过敏反应管理，肾上腺素的使用，和后续care.Conclusion：我们使用了NGT共识的方法来开发一个教育资源的初级保健医生和过敏症专科医生，以更好地了解如何管理过敏反应患者。下一步包括根据初级保健环境中观察到的数据测试我们的发现，并开发其他策略或工具来克服过敏反应管理中的差距。
Background: Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts.Methods: The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management of anaphylaxis in primary care. Physician-specific gaps from our systematic review were prioritized by consensus meeting participants in two rounds, which involved the rating, discussion, and re-rating of gaps. Using current anaphylaxis guidelines, recommendations were then developed for each category of gaps that were identified by the panel as clinically important.Results: Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and when and how to use epinephrine auto-injectors as clinically important knowledge gaps; and rated infrequent or delayed epinephrine administration, low rate of auto-injector prescription, and infrequent or no referrals to allergy specialists after a reaction as important practice behavior gaps. Evidence from four guidelines was used to support the consensus recommendation statements for three resulting categories of gap themes: anaphylaxis management, epinephrine use, and follow-up care.Conclusion: We used an NGT consensus methodology to develop an educational resource for primary care physicians and allergists to better understand how to manage patients with anaphylaxis. Next steps include testing our findings against observed data in primary care settings and to develop other strategies or tools to overcome gaps in anaphylaxis management.