Changes in management of acute pancreatitis before and after the publication of evidence-based practice guidelines in 2003.
BACKGROUND
The Japanese Guidelines for the Management of Acute Pancreatitis was published in 2003. However, the impact of the guidelines on physicians' practice patterns has not been well known.


METHODS
To examine the current clinical practices in the management of acute pancreatitis, we conducted a questionnaire survey with members of three societies involved in the treatment of pancreatic diseases and abdominal emergency medical care. Questions included diagnostic and treatment processes considered important in the management of acute pancreatitis in addition to demographic data, experience in medical care, and areas of specialty of respondents. We also examined changes in the treatment of acute pancreatitis before and after publication of the Guidelines.


RESULTS
Of 1,000 society members to whom questionnaires were mailed, 590 responded. Respondents who had read the Guidelines also handled significantly more cases in the most recent 3 years. A variety of changes were observed in the performance of clinical practices before and after publication of the Guidelines. The use of amylase in the assessment of severity decreased significantly, while its use for determination of severity scores increased significantly after publication of the Guidelines. In treatment, use of a nasogastric tube in mild and moderate cases deceased after the Guidelines. The frequency of prophylactic use of antibiotics decreased with mild pancreatitis after publication of the Guidelines.


CONCLUSIONS
Although it is difficult to attribute these changes to the direct influence of the Guidelines, several changes were observed in performance of clinical practices in accordance with recommendations of the Guidelines.
Sekimoto
Miho
M
Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe, Sakyo, Kyoto, 606-8501, Japan. msekimot@pbh.med.kyoto-u.ac.jp
Shikata
Satoru
S
Takada
Tadahiro
T
Hirata
Koichi
K
Yoshida
Masahiro
M
Hirota
Masahiko
M
Kitamura
Nobuya
N
Shirai
Kunihiro
K
Kimura
Yasutoshi
Y
Wada
Keita
K
Amano
Hodaka
H
Kiriyama
Seiki
S
Arata
Shinju
S
Gabata
Toshifumi
T
Hirota
Morihisa
M
Takeda
Kazunori
K
Yokoe
Masamichi
M
Mayumi
Toshihiko
T
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007564:Japan; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D055815:Young Adult
D008049:Lipase