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Original research
Sustainability assessment of a quality improvement initiative on the management of bronchiolitis
  1. Marta Montejo1,
  2. Natalia Paniagua2,
  3. Jose Ignacio Pijoan3,4,
  4. Carlos Saiz-Hernando5,
  5. Alvaro Sanchez6,
  6. Mikel Rueda-Etzebarria6,
  7. Javier Benito2
  1. 1Rontegi-Barakaldo Primary Care Center, Basque Health Service, Biobizkaia Health Research Institute, Barakaldo, Spain
  2. 2Pediatric Emergency Department, Cruces University Hospital, Basque Health Service, Biobizkaia Health Research Institute, Barakaldo, Spain
  3. 3Clinical Epidemiology Unit, Cruces University Hospital, Basque Health Service, Biobizkaia Health Research Institute, Barakaldo, Spain
  4. 4CIBER of Epidemiology and Public Health, (CIBERESP), Barakaldo, Spain
  5. 5Department of Medical Documentation, Cruces University Hospital, Basque Health Service, Biobizkaia Health Research Institute, Barakaldo, Spain
  6. 6Primary Care Research Unit of Bizkaia, Basque Health Service, Biobizkaia Health Research Institute, Barakaldo, Spain
  1. Correspondence to Dr Javier Benito; javier.benitof{at}osakidetza.eus

Abstract

Background A bronchiolitis integrated care pathway (BICP) achieved an 87% reduction in the use of medications in our regional health service (RHS) during the 2019–2020 season.

Aim This study aimed to assess the sustainability of the changes in bronchiolitis management over 3 years after implementation of the BICP.

Methods A prospective observational study on rates of medications prescribing in children diagnosed with bronchiolitis in 135 primary care (PC) centres and eight hospital emergency departments (EDs) in the Basque Country, Spain, was conducted during the four bronchiolitis seasons between 2019 and 2023. Over this period, the deployment of BICP-related actions continued in our RHS. In addition, a strategy was designed to enhance the sustainability of the results. The main endpoint was the percentage of children prescribed salbutamol.

Results Over the 2019–2020 to 2022–2023 epidemic waves, 12 966 infants were diagnosed with bronchiolitis in PC, and 6676 infants in EDs. Rates of salbutamol use over the four waves were 5.04%, 10.54%, 8.51% and 6.05%, respectively, in PC and 3.36%, 10.02%, 7.62% and 5.77% in EDs. Rates of concomitant administration of other medications in EDs over the four waves were 3.2%, 0.2%, 1.0% and 1.9% for epinephrine and 0.4%, 0.7%, 0.3% and 0.4% for corticosteroids, respectively. In PC, prescribing rates were 5.1% and 1.8%, 10.3% and 4.1% for antibiotics and 7.8% and 4.5%, 5.7% and 2.5% for corticosteroids, respectively.

Conclusions Reductions in the use of medications for bronchiolitis achieved in 2019 through the implementation of our integrated clinical pathway have been sustained over the three subsequent waves.

  • Paediatric Emergency Medicine
  • Qualitative research
  • Respiratory Medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2024-327602

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @JavierBenitoF

    • Contributors MM and JB (guarantor) conceptualised and designed the study, supervised the data collection, analysed the data and wrote and critically revised the initial draft of the manuscript. NP collaborated in the study design and wrote and critically revised the initial draft of the manuscript. JIP analysed the data, revised multiple versions of the manuscript and decisively contributed to the latest version of the manuscript. CS-H collaborated in the design of the study, participated in data collection and critically revised the manuscript. AS collaborated in the design of the study, participated in data collection, revised multiple versions of the initial manuscript and critically revised the final manuscript. MR-E participated in data collection, revised multiple versions of the initial manuscript and critically revised the final manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding This project was funded by Instituto de Salud Carlos III (ISCIII), cofunded by the European Union (European Regional Development Fund ‘A way to make Europe’), through project PI19/00234 and cofunded by the European Union–Next Generation EU funds, that financed the actions under the Recovery and Resilience Facility, through project RD21/0016/0003.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.