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GPs go forth

Most GPs did not alter bronchiolitis hospital referrals following NICE guideline

Only 7% of GPs changed their viral bronchiolitis practice as a ‘direct result’ of NICE guidelines, a new study has reported.

The BMJ study, which compared GP responses before and after the guidelines, found there were ‘small but significant improvements in reported patient care by UK GPs’, with 25% of GPs reporting they had changed their practice, although only 7% stated this was a direct result of the guidelines.

NICE guidelines, published in June 2015, included the recommendation that children should not be prescribed antibiotics, systemic or inhaled corticosteroids, or a combination of systemic corticosteroids and nebulised adrenaline, for the treatment of bronchiolitis.

Researchers received responses to an electronic questionnaire from 1,000 GPs in the UK in March 2015 and in May 2016. 

Despite the small changes in prescriptions, the authors noted that 84% of GPs had not changed their hospital referral pattern, and only 8% said they referred fewer, while 8% said they referred more.

Viral bronchiolitis has been named as a leading cause of hospitalisation for infants under one, with admissions rising on average by 1.8% each year, despite the number of cases requiring intensive care remaining steady since 2004.

It was also observed that 24% of the respondents still prescribed corticosteroid, including a large proportion of oral corticosteroid, which they stated are not recommended for infants due to a lack of evidence to support effectiveness and the potential adverse events.

The study did however note a decrease of 2% in oral antibiotic prescriptions, from 7% to 5%, which are likewise not recommended by NICE.

Dr Imran Rafi, chair of clinical innovation and research at the RCGP, said: ‘NICE guidelines are very helpful for GPs in developing treatment plans, but they are guidelines and ultimately GPs will make decisions based on the best interests of the patient sitting in front of them.’

‘This research does not show significantly worse outcomes for patients when NICE guidelines for bronchiolitis haven’t been strictly followed. Diagnosis of cases of bronchiolitis need to be made on a case-by-case basis, taking into account the specific clinical symptoms that a patient presents with, as there is so much overlap with symptoms that could indicate other conditions.’

Dr Duncan Keeley, policy lead at the Primary Care Respiratory Society UK and GP in Oxfordshire, said, ‘The NICE guidelines are broadly sensible and practical, however the study is showing that some GPs are still prescribing medication without evidence.’

‘The main issue is the prescription of oral corticosteroid, as there isn’t any evidence of their effectiveness. The problem is that it is for some doctors a change in practice, which is always difficult to achieve.’

Readers' comments (8)

  • The Bawa-Garba effect...every

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  • I had no clue doctors prescribed steroids or antibiotics for bronchiolitis. They weren't doing it in my paeds job over a decade ago.

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  • oh for the diagnostic certainty of hindsight; it turned out to have been bronchiolitis, so that prescription for possible sepsis or pneumonia was obviously wrong. Why did you follow that wheezy baby pathway and not this ill baby pathway, both have tachypnoea as key symptoms, but in retrospect and guideline club there is never any overlap.

    When the evidence reflects the actual situation and not some imaginary ideal world than it might influence practice.

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  • If some of the stuff they put out regularly in any way reflected the reality of the consultation I might partake. Looks like the results of the survey suggest that most GPs regard NICE utterances as a pile of unrealistic poo.

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  • Agree with all comments above. I am guessing Dr Keeley does one clinical session a week and it detached from the realities of the coal face.

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  • Lions led by Donkeys ,as it always is in the UK.

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  • Can we please shut NICE down? Its wasting resources and puts GPs at risk of litigation.

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  • hospital admission for wheezy babies is dictated by anxiety by GP or parents re this individual baby's safety. Can't see that this guideline does anything to negate that spidey sense that a baby needs to be in a place of safety

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