Knowledge, attitudes and practice styles of North American pediatricians regarding gastroesophageal reflux disease.
BACKGROUND
The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition launched a provider and public education campaign in 2002 to raise awareness of gastroesophageal reflux disease (GERD). To determine the effectiveness of campaign messages, we conducted a knowledge, attitudes, and practice styles (KAPS) survey of pediatric providers. Understanding the spectrum of management styles of GERD in children is critical to achieve better health outcomes and reduce health care costs.


METHODS
The KAPS questionnaire was administered to 6000 randomly selected members of the American Academy of Pediatrics.


RESULTS
A total of 1245 members responded; 82% worked in a primary care setting and 18% in subspecialty practices. Overall, 66% of the members order diagnostic testing in routine practice, 54% start testing for GERD in neonates, and 38% start testing after 1 month of age. The most common tests ordered were barium esophagram (45%) and esophageal pH monitoring (37%). GERD treatment with acid suppression before ordering diagnostic testing was a choice of 82% of the respondents. However, 19% believed acid suppression was best achieved by H2 blockers. If acid suppression was indicated, then only 36% followed guideline recommendations for therapy duration and 52% followed guideline recommendations for dosing. Antireflux surgery was recommended only as a last resort by 92%. Overall, 69% of providers believed the amount of GERD-related information available was not enough. Respondents who were not aware of available GERD practice guidelines ranged from 74% to 92%.


CONCLUSIONS
Pediatric providers appear to frequently order diagnostic testing and treatment for GERD, yet knowledge about evidence-based GERD management among this random sample appeared limited. Moreover, a significant number of providers were not aware of different guideline publications.
Diaz
Diego M
DM
Emory University School of Medicine, Atlanta, GA 30322, USA.
Winter
Harland S
HS
Colletti
Richard B
RB
Ferry
George D
GD
Rudolph
Colin D
CD
Czinn
Steven J
SJ
Cochran
William
W
Gold
Benjamin D
BD
D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009656:North America; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires