Guideline adherence for the treatment of advanced

Authors: Fangying Zhong Chenxi Liu Xinping Zhang

Publish Date: 2014/10/02

Volume: 113, Issue: 12, Pages: 4535-4541

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Abstract

This study compared physicians’ practices on three treatment procedures and hospitalization days with guideline recommendations to assess guideline adherence in the treatment of advanced schistosomiasis japonica Descriptive statistics were used to estimate patients’ characteristics and rate of guideline adherence And chisquare tests were used to assess influences of severity of the disease on guideline adherence The study found no one 0/173 adhered to adequate diagnosis treatment regimens and discharge criteria of guidelines completely And 223  of patients in group 1 and 423  in group 2 were totally conforming to adequate diagnosis 9191  of patients were conforming to adequate treatment regimens among which group 1 and group 2 were 9032 and 9225  respectively And one 223  patient in group 1 and zero 0  in group 2 were conforming to discharge criteria of guidelines and most of the patients left hospital without symptom checks 151/173 liver function and biochemical tests 169/173 and complication checks 91/173 Among 173 inpatients rate of adequate hospitalization days was 3642  63/173 And chisquare test suggested no significant difference P  005 on guideline adherence in two groups which implied both of critical and general patients’ treatments should be stressed to comply with guidelines There existed a large gap between guidelines and practices of the treatment of advanced schistosomiasis japonicaClinical practice guidelines have proliferated in recent decades as an attempt to improve the effectiveness and efficiency of health care McCormack and Loewen 2007 Emphasis on the development and implementation of guidelines has been fueled by research documenting high rates of inappropriate care and wide variations in clinical practice for common health care conditions McGlynn et al 2003 Bampton et al 2007 Adherence to clinical practice guidelines is advocated as a method to decrease utilization of ineffective therapies and increase adoption of evidencebased practices ultimately resulting in improved patient outcomes and more costeffective care Belief in the ability of guidelines to improve quality of care has led to a rapid proliferation in the number of guidelines available for a wide variety of clinical conditions Larson 2003 Walter et al 2009 Moonen and Cohe 2011 Although the primary goal of clinical practice guidelines is to improve quality few of researches have actually examined the impact of adherence to guideline recommendations on clinical diagnosis treatment regimens and discharge criteria Fritz et al 2007Schistosomiasis affects about 74 countries and regions containing 200 million people worldwide and more than 650 million people live in endemic areas Several million people all over the world suffer from severe morbidity as a consequence of schistosomiasis Its infections impose a great burden on poor populations in the developing world WHO 2006 China is an endemic area of schistosoma japonica and one of the four countries most seriously harmed by schistosomiasis in the globe Ren 2009 Zhu et al 2010 Much billion Yuan was expended to control the disease with the majority of costs related to prevention as well as prescription medication Like other common conditions inappropriate variations in care and unacceptably high use of ineffective therapies might lead to serious organic injury or complication such as upper gastrointestinal bleeding UGB Chen 2002 All of the above calls for increased adherence to clinical practice guidelines of schistosomiasisAlthough all patients with schistosomiasis seek care and receive therapy in the local lazaret or the designated hospital and they are managed in local Center for Disease Control and Prevention CDC there still exists incorrect and unreliable diagnosis etc Feng et al 2011 Because of serious consequence of schistosomiasis many clinical practice guidelines have been developed to direct primary care providers towards more evidencebased management Lugtenberg 2011 Guidelines provide a series of active criteria for clinical diagnosis and treatment regimens so that passive treatment could be minimized Hope et al 2008 Therefore adherence to guidelines by clinicians managing patients with schistosomiasis has been of great concernThe principle of diagnosis and treatment guideline is accordant with most patients so guideline adherence should be promoted Shao 2012 Fenwick et al 2009 However study exploring the adherence to guideline recommendations of schistosomiasis is lacking Most researches have examined the impact of adherence on costs and processrelated variables Cretin et al 2007 The study took clinical diagnosis treatment regimens and discharge criteria into consideration and analyzed the targets in relation to guideline adherence And our study by presetting a research hypothesis devoted that there was approving guideline adherence in the treatment of patients with advanced schistosomiasis The main purpose of this study was to examine adherence to the guideline recommendations for the practice provided by physicians to patients with advanced schistosomiasis and finally to promote rational and adequate schistosomiasis care

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