Treating Children's Infections More Efficiently

Bronchiolitis treatment in children involved fewer resources after guidelines were introduced

(RxWiki News) Often, more care is not necessarily better care. For certain conditions, such as bronchiolitis in children, extra medications or other treatments may not help recovery.

The American Academy of Pediatrics introduced guidelines in 2006 to help doctors determine the best care for kids with bronchiolitis.

A recent study found that many hospitals and doctors have been following those guidelines, but there is still improvement to be made.

For example, use of most medications for bronchiolitis decreased, but use of antibiotics did not decrease.

Another positive finding, however, was that use of chest x-rays decreased.

"Ask your doctor to explain your child's treatment plan."

This study, led by Kavita Parikh, MD, of the Division of Hospitalist Medicine at Children’s National Medical Center in Washington, DC, looked at the impact of introducing new guidelines for treatment of bronchiolitis.

Typically, the best treatment for bronchiolitis is rest and general supportive care.

There is not strong evidence showing that various antibiotics, other medications or other interventions help to effectively treat the condition.

"This clinical practice guideline emphasizes supportive care with oxygen and hydration (when necessary) and recommends limited use of diagnostic testing and medications, including bronchodilators, corticosteroids and antibiotics," the authors of this study noted.

Bronchodilators are medications that enlarge the airways to allow better airflow to the lungs.

These researchers examined the data for 130,262 patients, aged 1 month to 2 years old, who were treated for bronchiolitis between 2004 and 2012.

The average age of the children, treated at one of 41 pediatric hospitals, was 4 months old.

The children were divided in three groups: those treated before the guidelines were implemented, those treated very soon after the guidelines were introduced and those treated well after the guidelines had been implemented.

Overall, the researchers did not see major changes in treatment or care of patients across the first two groups, as the guidelines were being introduced.

For the children treated well after the guidelines, however, the researchers found significant reductions in the services used.

For example, there were fewer uses of diagnostic tests for the children; finding out a specific test result does not necessarily change the treatment of bronchiolitis.

The researchers also found a decrease in the use of steroid and bronchodilator medications.

Use of antibiotics, however, did not appear to drop after the introduction of the guidelines.

Yet the drop in the other services were likely related to the introduction of the guidelines.

"Although we cannot demonstrate a causal relationship, this reduction of diagnostic testing and treatment resources for bronchiolitis after guideline publication is striking and may be reducing costs associated with this common respiratory illness," the researchers wrote.

The authors of this study estimated that bronchiolitis is responsible for approximately $543 million each year in hospitalization costs.

Reducing unnecessary medical treatments can help save money while not increasing risks for patients.

However, it is also important for additional studies to ensure that risks for patients do not, in fact, increase with the decreased tests and treatments, according to Adam Powell, PhD, a health economist and President of Payer+Provider Syndicate.

"This study provides evidence that the AAP Guidelines improved the process quality of care and reduced the utilization of testing," he said.

"However, the study did not examine the quality of the outcomes that resulted - the health of the children treated under the AAP Guidelines," Dr. Powell added. "If additional research can demonstrate that the AAP Guidelines maintain or improve outcomes, we can safely promote them as a way of reducing the cost of bronchiolitis management."

This study was published December 2 in the journal Pediatrics. The research was funded by the Academic Pediatric Association. The authors reported no conflicts of interest.

Review Date: 
December 5, 2013