Evidence into practice; upper respiratory tract infections in children

Abstract

Transfer of evidence into practice is often slow and therefore remains an important challenge. Factors influencing this process include awareness and agreement with available evidence, feelings about the applicability of the evidence to one’s own patients and pressure from patients to start or refrain from a particular treatment. The best chance of bridging the gap between health research and implementation in daily clinical practice is created by optimizing all steps of the research cycle. In this thesis we used the example of management of children with upper respiratory tract infections (URTI) to study several of the crucial steps in the research cycle. First strategies used to promote the uptake of evidence-based interventions in children with URTI in daily practice were studied. We identified ten studies, and concluded that multifaceted and computer strategies appeared to be most effective to promote the uptake of evidence into practice in the area of URTI in children. Thereafter we studied the balance between costs and effects of pneumococcal conjugate vaccinations (PCV) against AOM in children and found that key assumptions regarding the incidence and costs of AOM episodes have major implications on the estimated cost effectiveness. In an open randomised controlled trial the (cost-) effectiveness of adenoidectomy as compared to watchful waiting in children with recurrent URTI was studied. During the 2 year follow-up we found no relevant differences for the number of URTI. The prevalence of URTI decreased over time in both groups. We concluded that in children selected for adenoidectomy for recurrent URTI, immediate adenoidectomy results in an increase in costs, whereas it confers no clinical benefit over an initial watchful waiting strategy. (Results on cost are not publically available yet.) Subsequently, we performed an Individual Patient Data meta-analysis pooling the original data from 567 children of 3 trials on the effectiveness of adenoidectomy with or without tympanostomy tubes in children with otitis media with effusion (OME). We aimed to identify subgroups of children with OME who will most likely benefit from adenoidectomy and as such facilitate clinical decisions about surgery in OME. (Results are not publically available yet.) We also studied the process from design to publication of clinical research in general in all projects awarded by the Health Care Efficiency Research Program of the Netherlands Organization for Health Research and Development (ZonMw) (i.e., the Dutch “National Institutes of Health”) between 2001 and 2006. We compared the primary outcomes and subgroup analyses reported in the grant application, the trial registry, and their related publications. There was a large discrepancy between grant applications and publications regarding both primary outcomes and subgroup analyses, which is biased favouring statistical significance