Adesão de pediatras às diretrizes para doenças gastrointestinais

• Autor(a) principal: Vieira, Sarah Cristina Fontes
• Data de Publicação: 2019
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/13079
• topic: Gastroenterologia; Gastroenterologia pediátrica; Refluxo gastroesofágico; Alergia a alimentos; Pediatria; Guideline adherence; Pediatrics; Gastroesophageal reflux; Food allergy; CIENCIAS DA SAUDE

Introduction: Guidelines are publications of recommendations based on scientific evidence. They aim to improve and standardize health professional practice. Adherence to these protocols has been studied in different areas of Medicine and is usually poor even in favorable socioeconomic contexts. Although gastrointestinal diseases in children are prevalent and have a high burden on morbidity, mortality and costs, pediatricians' adherence to guidelines for digestive tract diseases is still poorly studied. Objective: To evaluate Brazilian pediatricians’ adherence to guidelines for gastrointestinal diseases. Methods: Two observational, cross-sectional studies were conducted by two surveys among Brazilian pediatricians, randomly selected during two Brazilian Congress of Pediatrics (BCP). The first one was conducted during the 37th BCP in Rio de Janeiro-RJ, October-2015, and evaluated the adherence of pediatricians to the guideline with joint recommendations of the European and North American Societies of Pediatric Gastroenterology on management of Gastroesophageal Reflux (GER) in children. A standardized questionnaire previously used in an European multicenter study, translated to Portuguese, was applied. The second study was performed during the 38th BCP in Fortaleza-CE, October-2017, and evaluated Brazilian pediatricians' adherence to the Brazilian Food Allergy Consensus and international guidelines, we also evaluated awareness of adherence and reasons for intentional non-adherence with the guidelines. A questionnaire was developed and the Delphi technique was used for content validation with 6 experts in the field, in five rounds. In both studies, the interviewees’ characteristics and adherence rate were evaluated. Predictors of adherence were identified in logistic regression analysis. Results: In the first study, a total of 390 Brazilian pediatricians from the five regions of the country answered the questionnaire. None showed complete adherence to guideline recommendations. The adherence rate for GER diagnosis and treatment was 23.7% and 42%, respectively. Working in public health services (p = 0.026) was the only variable retained as a significant predictor of poor adherence for GER diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (p = 0.774). In the second study, a total of 415 pediatricians from the five regions of the country were interviewed. None showed complete adherence to Brazilian consensus and international guidelines and 69 (16,7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables ‘evaluating more than 10 children with suspected cow's milk allergy (CMA) per month' and 'having read the Brazilian consensus', or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of respondents (20.3-43.5% variation) did not know if their approach was following the guidelines. Conclusions: Brazilian pediatricians’ adherence to the recommendations in consensus and guidelines for GERD and Food Allergy is poor. When adherence to Food Allergy recommendations is present, it is mostly unconscious. Be aware of the recommendations and attend a larger number of children with suspected food allergy favors the adherence to recommendations.