Evaluating the impact of 2006 clinical practice guidelines for nutrition in children with cystic fibrosis in Australia.

Abstract

Objectives: To determine the association between the implementation of the 2006 Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis (CF) and the nutritional status of children participating in the Australian Cystic Fibrosis Data Registry (ACFDR) until 2014. Method(s): This mixed methods research consisted of a historical cohort study using ACFDR data and a survey of clinicians treating children with CF. Two cohorts of children (<6 and 6-11 years) were selected from ACFDR within 1998-2005 (n = 1987) and followed longitudinally until 2014. Nutritional status was assessed using weight and height z-scores for each patient on the occasion of best lung function annually. Generalised estimating equation model adjusted for sex, age, use of dornase alfa, number of ever colonised positive sample of pseudomonas and G551D mutation compared the period of 1998-2006 (pre-implementation) and 2007-2014 (post-implementation). A nationwide online survey was sent to 50 CF clinicians to explore their views on the impact of guidelines. Result(s): Data analysis showed significant increases (p < 0.05) in mean weight and height z-scores (0.16, 95%CI: 0.10-0.22 and 0.05, 95%CI: 0.00-0.10 respectively) after 2007, in those <6 years. The effectwas more marked among those aged 6-11, with mean changes inweight and height z-scores significantly improving after the implementation of guidelines (0.28, 95% CI: 0.02-0.54 and 0.33, 95%CI: 0.07-0.59 respectively). Survey results are undergoing analysis and will be presented at the conference. Conclusion(s): Study results suggest that in children participating in the ACFDR, nutritional status improved after the implementation of the 2006 guidelines. Survey results will allow us to identify enablers and barriers to guideline implementation and inform implementation strategies for the revised Australasian nutrition guidelines for CF, released in late 2017.