Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines

Jessica Gold, Patricia A. Hametz, Anita I. Sen, Philip Maykowski, Nicole Leone, Diana S. Lee, Christina Gagliardo, Saul Hymes, Rachel Biller, Lisa Saiman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Practice guidelines have been published for bronchiolitis and community-acquired pneumonia (CAP), but little is known about pediatricians' knowledge of and attitudes toward these guidelines since their publication. METHODS: We surveyed pediatric providers at 6 children's hospitals in the New York City area. Two vignettes, an infant with bronchiolitis and a child with CAP, were provided, and respondents were asked about management. Associations between respondent characteristics and their reported practices were examined using χ2 and Fisher's exact tests. Associations between questions probing knowledge and attitude barriers relevant to guideline adherence and reported practices were examined using Cochran-Mantel-Haenszel relative risk estimates. RESULTS: Of 283 respondents, 58% were trainees; 57% of attending physician respondents had finished training within 10 years. Overall, 76% and 45% of respondents reported they had read the bronchiolitis and CAP guidelines, respectively. For the bronchiolitis vignette, 40% reported ordering a chest radiograph (CXR), and 38% prescribed bronchodilators (neither recommended). For the CAP vignette, 38% prescribed ceftriaxone (not recommended). Study site, level of training, and practice locations were associated with nonrecommended practices. Site-adjusted knowledge and attitude barriers were used to identify that those who agreed CXRs were useful in managing bronchiolitis were more likely to order CXRs, and those who felt bronchodilators shortened length of stay were more likely to prescribe them. Concerns about ampicillin resistance and lack of confidence using local susceptibility patterns to guide prescribing were associated with ordering ceftriaxone. CONCLUSIONS: Provider-level factors and knowledge gaps were associated with ordering nonrecommended treatments for bronchiolitis and CAP.

Original languageEnglish (US)
Pages (from-to)87-91
Number of pages5
JournalHospital pediatrics
Volume9
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Health Knowledge, Attitudes, Practice
Bronchiolitis
Pneumonia
Guidelines
Ceftriaxone
Bronchodilator Agents
Ampicillin Resistance
Guideline Adherence
Practice Guidelines
Publications
Length of Stay
Thorax
Surveys and Questionnaires
Pediatrics
Physicians

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

Cite this

Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines. / Gold, Jessica; Hametz, Patricia A.; Sen, Anita I.; Maykowski, Philip; Leone, Nicole; Lee, Diana S.; Gagliardo, Christina; Hymes, Saul; Biller, Rachel; Saiman, Lisa.

In: Hospital pediatrics, Vol. 9, No. 2, 01.02.2019, p. 87-91.

Research output: Contribution to journalArticle

Gold, J, Hametz, PA, Sen, AI, Maykowski, P, Leone, N, Lee, DS, Gagliardo, C, Hymes, S, Biller, R & Saiman, L 2019, 'Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines', Hospital pediatrics, vol. 9, no. 2, pp. 87-91. https://doi.org/10.1542/hpeds.2018-0211
Gold, Jessica ; Hametz, Patricia A. ; Sen, Anita I. ; Maykowski, Philip ; Leone, Nicole ; Lee, Diana S. ; Gagliardo, Christina ; Hymes, Saul ; Biller, Rachel ; Saiman, Lisa. / Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines. In: Hospital pediatrics. 2019 ; Vol. 9, No. 2. pp. 87-91.
@article{5fa71d75db6f4688bd1876a9eeed1bb4,
title = "Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines",
abstract = "BACKGROUND AND OBJECTIVES: Practice guidelines have been published for bronchiolitis and community-acquired pneumonia (CAP), but little is known about pediatricians' knowledge of and attitudes toward these guidelines since their publication. METHODS: We surveyed pediatric providers at 6 children's hospitals in the New York City area. Two vignettes, an infant with bronchiolitis and a child with CAP, were provided, and respondents were asked about management. Associations between respondent characteristics and their reported practices were examined using χ2 and Fisher's exact tests. Associations between questions probing knowledge and attitude barriers relevant to guideline adherence and reported practices were examined using Cochran-Mantel-Haenszel relative risk estimates. RESULTS: Of 283 respondents, 58{\%} were trainees; 57{\%} of attending physician respondents had finished training within 10 years. Overall, 76{\%} and 45{\%} of respondents reported they had read the bronchiolitis and CAP guidelines, respectively. For the bronchiolitis vignette, 40{\%} reported ordering a chest radiograph (CXR), and 38{\%} prescribed bronchodilators (neither recommended). For the CAP vignette, 38{\%} prescribed ceftriaxone (not recommended). Study site, level of training, and practice locations were associated with nonrecommended practices. Site-adjusted knowledge and attitude barriers were used to identify that those who agreed CXRs were useful in managing bronchiolitis were more likely to order CXRs, and those who felt bronchodilators shortened length of stay were more likely to prescribe them. Concerns about ampicillin resistance and lack of confidence using local susceptibility patterns to guide prescribing were associated with ordering ceftriaxone. CONCLUSIONS: Provider-level factors and knowledge gaps were associated with ordering nonrecommended treatments for bronchiolitis and CAP.",
author = "Jessica Gold and Hametz, {Patricia A.} and Sen, {Anita I.} and Philip Maykowski and Nicole Leone and Lee, {Diana S.} and Christina Gagliardo and Saul Hymes and Rachel Biller and Lisa Saiman",
year = "2019",
month = "2",
day = "1",
doi = "10.1542/hpeds.2018-0211",
language = "English (US)",
volume = "9",
pages = "87--91",
journal = "Hospital pediatrics",
issn = "2154-1663",
publisher = "American Academy of Pediatrics",
number = "2",

}

TY - JOUR

T1 - Provider Knowledge, Attitudes, and Practices Regarding Bronchiolitis and Pneumonia Guidelines

AU - Gold, Jessica

AU - Hametz, Patricia A.

AU - Sen, Anita I.

AU - Maykowski, Philip

AU - Leone, Nicole

AU - Lee, Diana S.

AU - Gagliardo, Christina

AU - Hymes, Saul

AU - Biller, Rachel

AU - Saiman, Lisa

PY - 2019/2/1

Y1 - 2019/2/1

N2 - BACKGROUND AND OBJECTIVES: Practice guidelines have been published for bronchiolitis and community-acquired pneumonia (CAP), but little is known about pediatricians' knowledge of and attitudes toward these guidelines since their publication. METHODS: We surveyed pediatric providers at 6 children's hospitals in the New York City area. Two vignettes, an infant with bronchiolitis and a child with CAP, were provided, and respondents were asked about management. Associations between respondent characteristics and their reported practices were examined using χ2 and Fisher's exact tests. Associations between questions probing knowledge and attitude barriers relevant to guideline adherence and reported practices were examined using Cochran-Mantel-Haenszel relative risk estimates. RESULTS: Of 283 respondents, 58% were trainees; 57% of attending physician respondents had finished training within 10 years. Overall, 76% and 45% of respondents reported they had read the bronchiolitis and CAP guidelines, respectively. For the bronchiolitis vignette, 40% reported ordering a chest radiograph (CXR), and 38% prescribed bronchodilators (neither recommended). For the CAP vignette, 38% prescribed ceftriaxone (not recommended). Study site, level of training, and practice locations were associated with nonrecommended practices. Site-adjusted knowledge and attitude barriers were used to identify that those who agreed CXRs were useful in managing bronchiolitis were more likely to order CXRs, and those who felt bronchodilators shortened length of stay were more likely to prescribe them. Concerns about ampicillin resistance and lack of confidence using local susceptibility patterns to guide prescribing were associated with ordering ceftriaxone. CONCLUSIONS: Provider-level factors and knowledge gaps were associated with ordering nonrecommended treatments for bronchiolitis and CAP.

AB - BACKGROUND AND OBJECTIVES: Practice guidelines have been published for bronchiolitis and community-acquired pneumonia (CAP), but little is known about pediatricians' knowledge of and attitudes toward these guidelines since their publication. METHODS: We surveyed pediatric providers at 6 children's hospitals in the New York City area. Two vignettes, an infant with bronchiolitis and a child with CAP, were provided, and respondents were asked about management. Associations between respondent characteristics and their reported practices were examined using χ2 and Fisher's exact tests. Associations between questions probing knowledge and attitude barriers relevant to guideline adherence and reported practices were examined using Cochran-Mantel-Haenszel relative risk estimates. RESULTS: Of 283 respondents, 58% were trainees; 57% of attending physician respondents had finished training within 10 years. Overall, 76% and 45% of respondents reported they had read the bronchiolitis and CAP guidelines, respectively. For the bronchiolitis vignette, 40% reported ordering a chest radiograph (CXR), and 38% prescribed bronchodilators (neither recommended). For the CAP vignette, 38% prescribed ceftriaxone (not recommended). Study site, level of training, and practice locations were associated with nonrecommended practices. Site-adjusted knowledge and attitude barriers were used to identify that those who agreed CXRs were useful in managing bronchiolitis were more likely to order CXRs, and those who felt bronchodilators shortened length of stay were more likely to prescribe them. Concerns about ampicillin resistance and lack of confidence using local susceptibility patterns to guide prescribing were associated with ordering ceftriaxone. CONCLUSIONS: Provider-level factors and knowledge gaps were associated with ordering nonrecommended treatments for bronchiolitis and CAP.

UR - http://www.scopus.com/inward/record.url?scp=85060927716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060927716&partnerID=8YFLogxK

U2 - 10.1542/hpeds.2018-0211

DO - 10.1542/hpeds.2018-0211

M3 - Article

VL - 9

SP - 87

EP - 91

JO - Hospital pediatrics

JF - Hospital pediatrics

SN - 2154-1663

IS - 2

ER -