title: [Assessment of adherence to Afssaps guidelines for the prescription of antifungals in pediatric hemato-oncology].
abstract: OBJECTIVE
  This study had for aim to identify factors limiting the implementation of clinical guidelines related to the use of expensive antifungal drugs in pediatric hemato-oncology.
  
  
  METHODS
  A retrospective study was conducted in a Lyon teaching hospital (France), from February to December 2008. The compliance of antifungal prescription to French guidelines was assessed. Audit findings were interpreted using both semi-directed interviews of six prescribers (qualitative approach) and statistical analysis of prescriptions (quantitative approach).
  
  
  RESULTS
  Fifty antifungal prescriptions were studied. The compliance with clinical guidelines reached 66% (CI 95% 52-80%). The semi-directed interviews revealed that five issues may have influenced the adherence of prescribers with recommended practices: the guidelines, the molecule, the prescriber, the child, and practice settings. The statistical analysis did not reveal any link between the prescriber's activities or his department and the compliance with guidelines. A significant association was found between the documentation of infection and the non-conformity of antifungal prescriptions (p=0.02).
  
  
  CONCLUSIONS
  This study, combining qualitative and quantitative assessments, addressed potential issues related to the implementation of guidelines in specific patient groups or to their adaptation in the context of pediatric hematology-oncology. Harmonization of practices related to the widespread use of antifungal associations is required.
authors.affiliation: UMR 5558, service de pharmacie, institut d'hémato-oncologie pédiatrique, 1 place Joseph-Renault, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Berthe
authors.forename: A
authors.initials: A
authors.lastname: Duclos
authors.forename: I
authors.initials: I
authors.lastname: Ray-coquard
authors.forename: C
authors.initials: C
authors.lastname: Colin
authors.forename: N
authors.initials: N
authors.lastname: Bleyzac
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000592:standards; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006402:Hematologic Diseases / Q000150:complications; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology; D009369:Neoplasms / Q000150:complications; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012955:Societies, Medical; D055815:Young Adult
chemical_list: D000935:Antifungal Agents