Palivizumab Often Prescribed Improperly in Primary Practice
Physician education improves adherence to patient selection guidelines, but not dosing
TUESDAY, Dec. 20 (HealthDay News) -- Physician oversight and education improves adherence to patient selection guidelines for palivizumab use, but fails to improve improper dosing, according to a study published online Dec. 19 in Pediatrics.
Keith M. Perrin, M.D., of the Children's Hospital of New Orleans, and Rodolfo E. Bégué, M.D., of the Louisiana State University Health Sciences Center, describe the implementation of a clinician education program on diagnosis and management of bronchiolitis with emphasis on palivizumab use over the course of two respiratory syncytial virus seasons in a large, general pediatrics office. The effect the intermediary clinician education intervention had on palivizumab use was assessed.
The researchers found that, in the 2009 to 2010 season, 46 percent of the requests for palivizumab were inappropriate, whereas, in the 2010 to 2011 season, following physician education, inappropriate requests decreased to 14 percent. About 30 percent of children received the indicated number of doses of medication, with minimal improvement observed over the two seasons.
"Our study revealed that there are important discrepancies in what the American Academy of Pediatrics recommends for the use of palivizumab and the actual practice in primary care. The discrepancies manifest in inadequate indications and inadequate number of doses. Our program, which was aimed at the practitioner level and based on education, standardization, and control of practice, improved the former (indications), leading to more targeted use and lower cost of palivizumab. But it had little effect on the latter (number of doses), which will require future system improvement," the authors write.