Brazilian pediatricians’ adherence to food allergy guidelines—A cross-sectional study

Vieira, Sarah Cristina Fontes; Santos, Victor Santana; Franco, Jackeline; Nascimento-Filho, Hiram Menezes; Barbosa, Kamilla de Oliveira e Silva Solis; Lyra-Jr, Divaldo Pereira de; Bastos, Kleyton de Andrade; Cipolotti, Rosana; Wayhs, Mônica Lisboa Chang; Vieira, Mário César; Solé, Dírceu; Morais, Mauro Batista de; Gurgel, Ricardo Queiróz

doi:10.1371/journal.pone.0229356

Cited by 8 publications

(8 citation statements)

References 43 publications

(88 reference statements)

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“…Although national guidelines recommend the early introduction of potentially allergenic foods, a great proportion of paediatricians seemed to have not incorporated the update in their practice. Lack of familiarisation with this specific recommendation has been reported by other authors (27,43,59) .…”

Section: Discussionmentioning

confidence: 86%

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

Vidal

Bové²,

Brunet

et al. 2021

Public Health Nutr.

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Objective: To explore Uruguayan paediatricians’ personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence. Design: A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored. Setting: Montevideo, the capital city of Uruguay (Latin America). Participants: A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics. Results: The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses. Conclusions: Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

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Section: Discussionmentioning

confidence: 86%

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

Vidal

Bové²,

Brunet

et al. 2021

Public Health Nutr.

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“…A poorly equipped physical work environment, with erratic drug supply, inadequate resources and infrastructure and insufficient financial resources, was most frequently cited as negatively impacting on compliance with clinical guidelines in LMICs 3 12–42. For instance, in Malaysia, the restricted availability of combination hypertensive drugs and lack of infrastructure for medication storage were deterrents to implementation of hypertension management clinical guidelines 21.…”

Section: Resultsmentioning

confidence: 99%

“…The use of clinical guidelines is influenced by factors relating to individual healthcare providers. Knowledge of evidence-based practice or awareness of the existence of clinical guidelines3 12–15 17 20 25 27 28 31 32 34 35 37 39 40 43 45 46 48 51 and the skill-level in clinical practice3 14 18 23 27 28 34 35 39 41 42 45 46 54 all impact on compliance with clinical guidelines. The use of clinical guidelines can be constrained by healthcare provider perceptions of the guidelines, including their confidence in the quality of clinical guidelines,37 42 44 views on whether the use of clinical guidelines threatens their professional autonomy,21 25 32 54 interest in or attitude to evidence-based management,13 16 22 prioritising experience or personal beliefs 14 19 27 43 47.…”

Section: Resultsmentioning

confidence: 99%

“…Knowledge of evidence-based practice or awareness of the existence of clinical guidelines3 12–15 17 20 25 27 28 31 32 34 35 37 39 40 43 45 46 48 51 and the skill-level in clinical practice3 14 18 23 27 28 34 35 39 41 42 45 46 54 all impact on compliance with clinical guidelines. The use of clinical guidelines can be constrained by healthcare provider perceptions of the guidelines, including their confidence in the quality of clinical guidelines,37 42 44 views on whether the use of clinical guidelines threatens their professional autonomy,21 25 32 54 interest in or attitude to evidence-based management,13 16 22 prioritising experience or personal beliefs 14 19 27 43 47. Individual beliefs on the consequences of guideline adherence including clinical outcomes, improving drug prescription efficiency, time and money savings and legal repercussions were also enablers in clinical guideline usage 30 35 52…”

Section: Resultsmentioning

confidence: 99%

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Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

Orangi,

Kabubei

et al. 2023

BMJ Open

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ObjectiveA scoping review was undertaken to determine the extent to which existing studies have examined factors influencing healthcare providers’ use of clinical guidelines in low and middle-income country (LMIC) settings and determine which factors constrain or facilitate the use of clinical guidelines by healthcare providers.DesignScoping review.Data sourcesThe literature search was conducted using PubMed in January 2021.Eligibility criteriaWe identified empirical studies, published between 2011–2021 in English, which included clinicians and/or nurses as healthcare providers, used a health facility as the study site, and were located in an LMIC.Data extraction and synthesisInformation extracted from the literature review was organised using themes and the findings synthesised using thematic analysis.ResultsThe review identified five types of interacting factors that influence healthcare providers’ use of and compliance with clinical guidelines. The factors identified are organisational factors, factors relating to individual healthcare providers, attributes of the clinical guidelines, patient-related factors and institutional factors. Organisational factors can be further divided into the physical work environment, organisational culture and working conditions. The effective use of clinical guidelines in LMIC settings is greatly impacted by the contextualisation of clinical guidelines, end-user engagement and alignment of the implementation of clinical guidelines with the institutional arrangements in the broader health system.ConclusionThe development and evaluation of concrete interventions is vital to facilitate the implementation of clinical guidelines and improve healthcare service quality. Further studies are necessary to examine the relative importance of the five identified factors on the effective use of clinical guidelines in different contexts.

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“…A more recent cross-sectional survey assessed adherence to food allergy clinical practice guidelines among 415 Brazilian pediatricians [12]. Responses of only a minority of participants (16.7%) reflected a satisfactory adherence rate (≥80%).…”

Section: Discussionmentioning

confidence: 99%

Discrepancy between Guidelines and Clinical Practice in the Management of Cow’s Milk Allergy in Children: An Online Cross-Sectional Survey of Polish Physicians

Stróżyk

Horvath

Jarocka-Cyrta

et al. 2022

Int Arch Allergy Immunol

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The aim of this study was to assess the compliance between current guidelines on the diagnosis and management of children with cow’s milk allergy (CMA) and clinical practice by a survey of Polish physicians. An online cross-sectional survey involving a convenience series of participants was performed from January 15 to March 20, 2020. Data provided by 605 physicians (74.2% of them pediatricians working in general practice) were analyzed. Contrary to the current recommendations, only a minority of respondents (27.4%) reported performing oral food challenge (OFC) to confirm the diagnosis of CMA. Among those who reported performing OFC (<i>n</i> = 160 respondents), the majority performed an open challenge (82.5%). Most respondents (79.2%) correctly recommended as the first-line treatment extensively hydrolyzed cow’s milk formula for a child with mild-to-moderate CMA. Less than half of participants (43.8%) recommended amino acid-based formula for a child with severe CMA (anaphylaxis). Only half of respondents (50.8%) reassessed tolerance to cow’s milk proteins. For assessing tolerance acquisition, more respondents recommended challenge to baked milk compared with fresh cow’s milk (60.5% vs. 39.5%, respectively). This survey study found that only a minority of responding physicians follow current guidelines for diagnosis and management of children with CMA in Poland.

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Brazilian pediatricians’ adherence to food allergy guidelines—A cross-sectional study

Cited by 8 publications

References 43 publications

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

Discrepancy between Guidelines and Clinical Practice in the Management of Cow’s Milk Allergy in Children: An Online Cross-Sectional Survey of Polish Physicians

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