44 - Factors Associated with Salbutamol Overuse in Bronchiolitis
Friday, April 28, 2023
5:15 PM – 7:15 PM ET
Poster Number: 44 Publication Number: 44.111
Marta Montejo, BioCruces Bizkaia Research Institute, Barakaldo, Pais Vasco, Spain; Natalia Paniagua, Cruces University Hospital, Bizkaia. Basque Country, Barakaldo, Bizkaia, Pais Vasco, Spain; Alvaro Sanchez, Osakidetza, Barakaldo, Pais Vasco, Spain; Jose I. Pijoan, Osakidetza/Basque Health Service, Barakaldo, Pais Vasco, Spain; Mikel Rueda-Etxebarria, Biocruces Bizkaia Health Research Institute, Bilbao, Pais Vasco, Spain; Carlos Saiz, Osakidetza - OSI EZKERRALDEA-ENKARTERRI-CRUCES, Barakaldo, Pais Vasco, Spain; Javier Benito, Cruces University Hospital, Bilbao, Pais Vasco, Spain
Director Pediatric Emergency Department Cruces University Hospital Bilbao, Pais Vasco, Spain
Background: Numerous studies have shown that it is possible to reduce the use of unnecessary interventions in the management of bronchiolitis, using quality improvement methods. Our experience suggests that the management of bronchiolitis is influenced by clinical as well as contextual factors that can reduce the effectiveness of the interventions put in place to discourage the overuse of medications Objective: To identify factors related to the overuse of salbutamol in the treatment of bronchiolitis in the context of an improvement initiative Design/Methods: We conducted an observational study of socio-demographic and clinical factors associated with the use of salbutamol in children diagnosed with bronchiolitis in 135 primary care (PC) centers and 8 pediatric emergency departments (EDs) in the Basque Country, Spain. Data were obtained from two seasons of bronchiolitis between which a quality improvement initiative had been implemented Results: We included 4,134 ED attendances and 8,573 PC visits, of which 1,936 (46.8%). and 4,067 (47.4%) occurred in the post-intervention period respectively. In the multivariate analysis, we identified six independent risk factors for the overuse of salbutamol in both seasons: age ≥1 year, aOR 2.32 (2.01 to 2.68) in PC centers, and aOR 6.84 (4.98 to 9.39) in EDs (p< 0.001); being seen in the last third of the bronchiolitis season, aOR 1.82 (1.51 to 2.18) in PC centers and aOR 1.78 (1.19 to 2.64) in EDs (p< 0.001); making more than one visit to the PC center, aOR 4.18 (3.32 to 5.27) or the ED, aOR 2.06 (1.59 to 2.66) (p< 0.001); being seen by a general practitioner, aOR 1.97 (1.58 to 2.46) in PC centers (p< 0.001); and having a more severe episode, aOR 3.01 (1.89 to 4.79) in EDs (p< 0.001)
Conclusion(s): There are factors associated with salbutamol overuse in children diagnosed with bronchiolitis in PC centers and EDs emergency settings that persist after the deployment of quality improvement initiatives
