An update on practice guidelines for primary care treatment of pediatric migraine

IntroductionNationally and internationally it is well recognised that dementia is poorly recognised and suboptimally managed in the primary care setting. There are multiple and complex reasons for this gap in care, including a lack of knowledge, high care demands and inadequate time for the general practitioner alone to manage dementia with its multiple physical, psychological and social dimensions. The primary care nurse potentially has a role in assisting the general practitioner in the provision of evidence-based dementia care. Although dementia-care guidelines for general practitioners exist, evidence on resources to support the primary care nurse in dementia care provision is scarce. The ‘Australian Clinical Practice Guidelines and Principles of Care for People with Dementia’ provides 109 recommendations for the diagnosis and management of dementia. This protocol describes a Delphi study to identify which of the 109 recommendations contained in these multidisciplinary guidelines are relevant to the primary care nurse in the delivery of person-centred dementia care in the general practice setting.Methods and analysisUsing a Delphi consensus online survey, an expert panel will grade each of the recommendations written in the ‘Clinical Practice Guidelines and Principles of Care for People with Dementia’ as high-to-low relevance with respect to the role of the primary care nurse in general practice. To optimise reliability of results, quality indicators will be used in the data collection and reporting of the study. Invited panel members will include Australian primary care nurses working in general practice, primary care nursing researchers and representatives of the Australian Primary Health Care Nurses Association, the peak professional body for nurses working in primary healthcare.Ethics and disseminationThis study has been approved by The University of Newcastle Human Research Ethics Committee (HREC) (H-2019-0029).Findings will be published in a peer-reviewed journal and presented at scientific conferences.

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Practice and Guidelines

PEDIATRICS ◽

10.1542/peds.97.4.604 ◽

1996 ◽

Vol 97 (4) ◽

pp. 604-605

Author(s):

John T. Benjamin

Keyword(s):

Primary Care ◽

Otitis Media ◽

Practice Guidelines ◽

Primary Care Pediatricians

As a former practicing pediatrician turned academic, I found the article entitled "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison with Published Practice Guidelines"1 interesting if not disturbing. Three case scenarios were sent to 194 pediatricians: a 3-week-old infant with fever, a 2-month-old infant with rales and bilateral otitis media, and a 20-month-old infant with fever. Ninety-four pediatricians responded and their workups and approaches to treatment compared to ‘practice guidelines" developed by Baraff et al.2

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The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines

PEDIATRICS ◽

10.1542/peds.95.5.623 ◽

1995 ◽

Vol 95 (5) ◽

pp. 623-627 ◽

Cited By ~ 1

Author(s):

Paul C. Young

Keyword(s):

Primary Care ◽

Practice Guidelines ◽

Laboratory Tests ◽

Blood Count ◽

Response Rate ◽

Expert Panel ◽

Complete Blood Count ◽

Age Groups ◽

Design Case ◽

Primary Care Pediatricians

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines. Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies. Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants. Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

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