Background
The American Heart Association (AHA) guidelines from 2007 and the American Society
for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic
prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis.
Objective
To determine physician knowledge regarding these guidelines and to identify physician
subgroups for which knowledge was suboptimal.
Design
A survey questionnaire was developed based on AHA and ASGE guidelines regarding antibiotics
before endoscopy. Physicians were queried about 10 theoretical scenarios as to whether
or not they would recommend before-procedure antibiotics.
Setting
The survey was administered at 3 academic medical centers.
Participants
Attending physicians and trainees in primary care and subspecialties.
Interventions
Survey.
Main Outcome Measurements
Percentage of the survey questions answered correctly and predictors of correct response.
Results
The survey was administered to 941 participants of whom 12 declined to participate.
Eighty percent (n = 740/929) of participants completed the survey. The median number
of correct answers was 70% (interquartile range [IQR] 50%-90%) and was similar at
each institution (P = .6). A total of 7.3% (n = 54) of respondents answered all questions correctly.
There was no significant difference in correct responses between attending physicians
and trainees or between study centers (median 7, IQR 5-9; P = .75). Gastroenterologists were more likely to answer questions correctly than other
subspecialists or primary care physicians (P < .0001). On multivariate analysis, physician knowledge correlated directly with
self-reported familiarity with guidelines (0.21; 95% confidence interval [CI], 0.08-0.34;
P = .002) and specialty (0.56; 95% CI, 0.30-0.82; P < .001) and inversely with year of medical school graduation (0.22; 95% CI, 0.07-0.37;
P = .005).
Limitations
Survey study that used theoretical scenarios.
Conclusion
Physician knowledge of guidelines regarding antibiotic use before endoscopy is suboptimal.
Further interventions are needed to improve the knowledge of before-procedure guidelines.
Abbreviations:
AHA (American Heart Association), ASGE (American Society for Gastrointestinal Endoscopy)To read this article in full you will need to make a payment
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References
- Open access endoscopy.Gastrointest Endosc. 2002; 56: 793-795
- Antibiotic prophylaxis for GI endoscopy.Gastrointest Endosc. 2008; 67: 791-798
- Prevention of bacterial endocarditis: recommendations by the American Heart Association.Circulation. 1997; 96: 358-366
- Infectious disease complications of GI endoscopy: Part I, endogenous infections.Gastrointest Endosc. 2003; 57: 546-556
- Prevention of infective endocarditis guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.Circulation. 2007; 116: 1736-1754
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Informat. 2009; 42: 377-381
- Institute of Medicine. Guidelines for clinical practice: from development to use.Washington, DC: The National Academies Press, 1992
- World Health Organization. Guidelines for WHO guidelines, v. 10. World Health Organization, Geneva2003: 1-23 (Global Programme on Evidence for Health Policy) (Accessed October 15, 2014)
- Crossing the quality chasm: a new health system for the 21st century, 1st ed.Washington, DC: National Academies Press, 2001
- From best evidence to best practice: effective implementation of change in patients' care.Lancet. 2003; 362: 1225-1230
- Systematic review: the relationship between clinical experience and quality of health care.Ann Intern Med. 2005; 142: 260-273
- The state of the art versus the state of the science. The diffusion of new medical technologies into practice.Int J Technol Assess Health Care. 1988; 4: 5-26
- Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings.BMJ. 1998; 317: 465-468
Article info
Publication history
Published online: April 01, 2015
Accepted:
January 4,
2015
Received:
July 25,
2014
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Feuerstein at [email protected]
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
