The effect of an interventional program on adherence to the american academy of pediatrics guidelines for palivizumab prophylaxis.
OBJECTIVE
To determine the effect of an interventional program designed to improve adherence to American Academy of Pediatrics (AAP) guidelines for palivizumab prophylaxis.


METHODS
The study was carried out at the Children's Hospital, University of California, Irvine Medical Center and its affiliated clinics. An interventional program focusing on education of health care workers on AAP guidelines, updating health care providers about respiratory syncytial virus (RSV) activity, as well as designating a single clinic with effective screening of referrals for administration of palivizumab, was implemented during the summer of 2004. The medical records of infants who had received at least 1 dose of palivizumab or were eligible to receive palivizumab during the 2003-2004 and the 2004-2005 RSV seasons at the University of California, Irvine Medical Center were reviewed. The proportion of patients who received injections according to AAP guidelines was compared.


RESULTS
After the intervention, the proportion of patients who received palivizumab injections according to AAP recommendations increased from 39% to 61% (P < 0.0001). The program decreased the proportion of unnecessary injections significantly (140/525, or 27%, in 2003-2004 to 33/323, or 10%, in 2004-2005; P < 0.0001) but did not change the proportion of missing injections. The program resulted in a significant drop (14% to 2%; P < 0.0001) in proportion of palivizumab injections that were given too late, when RSV activity had subsided. RSV hospitalization rates did not change as a result of the intervention.


CONCLUSIONS
Our interventional program improved adherence to AAP guidelines mainly by decreasing the unnecessary palivizumab injections.
Afghani
Behnoosh
B
Department of Pediatrics, University of California, Irvine, CA, USA. bafghani@uci.edu
Ngo
Thienkim
T
Leu
Szu-Yun
SY
Wu
Fu L
FL
Cecilio
Maricel
M
Aron-Johnson
Pamela
P
Zeitany
Raja
R
Sills
Jack
J
Amin
Alpesh
A
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018890:Chemoprevention / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control* / Q000821:virology; D000069455:Palivizumab; D015397:Program Evaluation; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control* / Q000821:virology; D012136:Respiratory Syncytial Viruses
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab