Adherence to clinical practice guidelines on the management of acute infectious gastroenteritis in children as a measure of quality of care delivered by a primary care facility in rural Philippines: A descriptive retrospective study.

Paul Johnny C Diaz; Leonila F Dans; April P Zamora; Josephine T Sanchez; Cara Lois T Galingana; Maria Rhodora D Aquino; Nanette B Sundiang; Herbert S Zabala; Jesusa T Catabui; Mia P Rey; Antonio L Dans

Return

Adherence to clinical practice guidelines on the management of acute infectious gastroenteritis in children as a measure of quality of care delivered by a primary care facility in rural Philippines: A descriptive retrospective study.

Author: Paul Johnny C. Diaz ¹ ; Leonila F. Dans ¹ ; April P. Zamora ¹ ; Josephine T. Sanchez ² ; Cara Lois T. Galingana ² ; Maria Rhodora D. Aquino ² ; Nanette B. Sundiang ² ; Herbert S. Zabala ² ; Jesusa T. Catabui ² ; Mia P. Rey ³ ; Antonio L. Dans ^{2
,

4}
Author Information

1. Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
2. Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman
3. Department of Accounting and Finance, Cesar E.A. Virata School of Business, University of the Philippines Diliman
4. Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila
Publication Type:Journal Article
Keywords: Infectious Gastroenteritis
MeSH: Diarrhea; Primary Health Care
From: Acta Medica Philippina 2024;58(16):58-67
CountryPhilippines
Language:English
Abstract: OBJECTIVES
This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH).
METHODS
A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low.
RESULTS
There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool eISSN 2094-9278 (Online) Copyright: © The Author(s) 2024 Published: September 13, 2024 https://doi.org/10.47895/amp.v58i16.7513 Corresponding author: Paul Johnny C. Diaz, MD Department of Pediatrics Philippine General Hospital University of the Philippines Manila Taft Avenue, Ermita, Manila 1000, Philippines Email: pcdiaz1@up.edu.ph ORCiD: https://orcid.org/0009-0005-0088-4541 analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%.
CONCLUSION
Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.
Full text:20241104094016417258.pdf