TY - JOUR
T1 - Mind the gap
T2 - Mapping variation between national and local clinical practice guidelines for acute paediatric asthma from the United Kingdom and the Netherlands
AU - Koldeweij, Charlotte
AU - Appelbaum, Nicholas
AU - Rodriguez Gonzalvez, Carmen
AU - Nijman, Joppe
AU - Nijman, Ruud
AU - Sinha, Ruchi
AU - Maconochie, Ian
AU - Clarke, Jonathan
N1 - Funding Information:
Two authors (NA and CK) had support from the National Institute for Health Research (NIHR, accessible from https://www.nihr.ac.uk/) Imperial Patient Safety and Translational Research Centre (PSTRC) PSTRC_2016_004. Infrastructure support for this work was provided by the NIHR Imperial Biomedical Research Centre (BRC) 1215-20013. JC acknowledges support from the Engineering and Physical Sciences Research Council (EPSRC, accessible from: https://epsrc. ukri.org/) grant EP/N014529/1 supporting the EPSRC Centre for Mathematics of Precision Healthcare and from the Wellcome Trust (accessible from: https://wellcome.org/), grant 215938/Z/19/Z. RN is the recipient of the NIHR Academic clinical fellowship and lectureship award NIHR ACL 2018-021-007. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2022 Koldeweij et al.
PY - 2022/5
Y1 - 2022/5
N2 - BACKGROUND: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands.METHODS: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. CPG quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II.RESULTS: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. The quality of the sampled local CPGs was low across all AGREE II domains.CONCLUSIONS: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.
AB - BACKGROUND: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands.METHODS: Fifteen British and Dutch local CPGs were collected with the matching national guidance for the management of acute asthma in children under 18 years old. The drug sequences, routes and methods of administration recommended for patients with severe asthma and the tone of recommendation across both types of CPGs were schematically represented. Deviations from national guidance were measured. Variation in recommended doses of intravenous salbutamol was examined. CPG quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II.RESULTS: British and Dutch national CPGs differed in the recommended drug choices, sequences, routes and methods of administration for severe asthma. Dutch national guidance was more rigidly defined. Local British CPGs diverged from national guidance for 23% of their recommended interventions compared to 8% for Dutch local CPGs. Five British local guidelines and two Dutch local guidelines differed from national guidance for multiple treatment steps. Variation in second-line recommendations was greater than for first-line recommendations across local CPGs from both countries. Recommended starting doses for salbutamol infusions varied by more than tenfold. The quality of the sampled local CPGs was low across all AGREE II domains.CONCLUSIONS: Local CPGs for the management of severe acute paediatric asthma featured substantial variation and frequently diverged from national guidance. Although limited to one condition, this study suggests that unmeasured variation across local CPGs may contribute to variation of care more broadly, with possible effects on healthcare quality.
UR - http://www.scopus.com/inward/record.url?scp=85130119149&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0267445
DO - 10.1371/journal.pone.0267445
M3 - Article
C2 - 35580117
SN - 1932-6203
VL - 17
JO - PLoS ONE
JF - PLoS ONE
IS - 5 May
M1 - e0267445
ER -