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Acta Paediatr ; 108(7): 1345-1349, 2019 07.
Article in English | MEDLINE | ID: mdl-30536910

ABSTRACT

AIM: To investigate differences in palivizumab prescription rates between Dutch paediatricians, and the role of parent counselling in this practice variation. METHODS: A retrospective chart review of premature infants <32 weeks of gestation, aged less than six months at the start of the winter season, born between January 2012 and July 2014, in three secondary hospital-based paediatric practices in the Netherlands. RESULTS: We included 208 patients, 133 (64%) of whom received palivizumab. Prescription rates varied considerably between the three hospitals: 8% (6/64), 89% (32/36) and 99% (97/98). A noticeable difference in the way parents were counselled about palivizumab was the use of the number needed to treat (NNT). In the hospital with the lowest prescription rate (8%), an NNT of 20 to prevent one hospitalisation was explicitly discussed with parents. Bronchiolitis-related hospital admissions occurred in 11.3% of patients receiving palivizumab compared to 20.0% in nonimmunised infants (p = 0.086). CONCLUSION: Considerable practice variation exists among Dutch paediatricians regarding palivizumab prescription rates. The counselling method seems to play an important role. Presenting palivizumab prophylaxis as a preference-sensitive decision, combined with the explicit use and explanation of an NNT, leads many parents to refrain from respiratory syncytial virus immunisation.


Subject(s)
Antiviral Agents/therapeutic use , Bronchiolitis, Viral/prevention & control , Palivizumab/therapeutic use , Pediatrics/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Counseling , Humans , Infant , Infant, Newborn , Infant, Premature , Netherlands , Parents/psychology , Patient Admission/statistics & numerical data , Retrospective Studies
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