Adherence of Primary Care Providers to Practice Guidelines for Common Pediatric Conditions in Urban, Rural, and Remote Sites in the Philippines: A Cross-Sectional Study

Abstract

Background. Evaluation of primary care allows for identification of problems in the healthcare system, such as poor health outcomes, inappropriate health services, overuse of unnecessary resources, or underuse of recommended strategies. Assessment of adherence to existing clinical practice guidelines as quality indicators is critical for evaluating the effectiveness of primary care and shaping healthcare policies.

Objectives. To determine the adherence of primary care providers to existing practice guidelines for common pediatric concerns in remote, rural, and urban areas in the Philippines.

Methods. This cross-sectional study included data from the electronic medical records (EMR) of patients aged
19 years and below who consulted at the three pilot sites of the Philippine Primary Care Studies (PPCS) from
January to December 2019. Relevant demographic data and quality indicator measures (e.g., immunization history, adolescent smoking history, medication and supplement prescription) were extracted from the EMR by the PPCS data management team. Adherence to existing guidelines on pediatric history taking and management of common illnesses (e.g., diarrhea, upper respiratory tract infections, malnutrition) was evaluated.

Results. This study included 8,724 pediatric patients seen across the three pilot sites from January to December
2019. Immunization history was taken in only 0.4% of pediatric patients. Smoking history was taken in only 6.8%
of adolescent patients. Zinc was prescribed in only 40.1% of patients with diarrhea. No infants were prescribed
with vitamin A, while iron was prescribed in only 2.5% of children and 3% of adolescent females. In contrast to the recommendations of existing guidelines, antibiotics were prescribed in 38.5% of patients with AGE and 62.5% of patients with viral URTI. Montelukast was prescribed as first-line asthma treatment in 4.7% of cases. Multivitamins were prescribed in 57.2% of all pediatric patients.

Conclusions. Overuse of inappropriate medications and underuse of appropriate interventions were observed in this study. There was low adherence to evaluation of pediatric immunization history, adolescent smoking history, zinc supplementation for diarrhea, and iron and vitamin A supplementation among identified vulnerable population groups. Over prescription of the following were observed: (1) antibiotics for acute gastroenteritis and probable viral URTI, (2) multivitamins for the general pediatric population, and (3) montelukast among newly diagnosed asthma patients.