Context: Synthetic corticosteroids are medications frequently prescribed for a wide range of medical indications. Various preparations differ in their biological effect, mode of administration, potency and duration of action. Comprehensive knowledge is essential in order to prescribe corticosteroids in an efficient yet safe manner.
Objectives: To explore pediatricians' practices and attitudes regarding corticosteroid administration and to determine whether intraprofessional practice gaps between general pediatricians and subspecialists exist.
Design, Participants and Methods: A cross-sectional, nationally representative, web-based survey was disseminated to Israeli registered board-certified pediatricians between February 4th and July 31st, 2018. The Pediatricians Corticosteroids Survey was generated in accordance with recommended survey methodology. Relevant items were developed through literature reviews and in-depth interviews with pediatricians from different disciplines at Dana-Dwek Children's Hospital. The items were grouped into domains: (A) demographics (B) corticosteroid prescription and (C) corticosteroid knowledge [subscores - 'corticosteroid potency and half life' maximum score of 7, 'tapering-down' and 'stress dose' each maximum score of 6, maximum total score of 19]. One-way-ANOVA was used to analyze survey outcomes and post hoc analysis (Tukey HSD test) was performed. Cronbach's alpha coefficients were 0.76 (domain B) and 0.83 (domain C) demonstrating internal consistency.
Results: 349 pediatricians (45.8% males) responded and completed the survey, 76.5% studied medicine in Israel; 207/349 (59%) had a pediatric subspecialty, 37/349 (10.6%) were pediatric endocrinologists. The responders were highly experienced physicians: 58% had over 10 years of pediatric clinical experience and 57.7% treat on average more than 60 patients per week. Nearly half of the responders (47.5%) estimated they prescribed corticosteroids to 10-30% of their patients and 7.5% to over 30% of their patients. Despite vast experience with corticosteroid usage, 4.1% responded 'not sure' when 'tapering of' steroids is required, 8.3% responded 'not sure' what 'stress dose' refers to and 10.1% responded 'not sure' when stress dose is required. Pediatric endocrinologists scored higher on all knowledge-based items compared to general pediatricians and other subspecialists (mean total score: 11.25±2.49 vs. 7.94±2.61 vs. 6.95±2.67, P<0.001 and in each of the subscores, P<0.001). Overall, 96.2% of respondents felt it would be helpful to participate in continued medical education sessions.
Conclusions: Substantial intraprofessional practice gaps exist between pediatric endocrinologists and general pediatricians and other subspecialists in both corticosteroid prescription practice and knowledge. Continued medical education programs on the topic of corticosteroids are warranted to improve clinician competence and performance and patient outcomes.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology