Variability in the management of bronchiolitis in the public first level of attention in Argentina

Bronchiolitis is a serious public health problem generating a great demand at the primary care level. To describe the frequency of diagnosis of and prescription for bronchiolitis at the primary care level in Argentina; and to estimate variability in clinical practice. Retrospective observational study based on the Remediar Program with cross comparisons of diagnosis and prescriptions by individual provinces. The Program prescriptions are the secondary sources of information. The target population consists of the universe of patients in 6000 centers encompassing 24 Argentine provinces that were prescribed drugs by Remediar, between March of 2005 and February of 2006. Fifteen million prescriptions were reviewed. The diagnosis of bronchiolitis was made with a frequency of 3.0% in the under 2 years of age group (n: 30.278 identified infants). The most frequently prescribed drugs were: antibiotics 48.4%, bronchodilators 41.4%, antipyretics 31% and corticosteroids 21.1%. The probability of diagnosis of bronchiolitis may vary up to four times, as well as the prescription of either salbutamol or antibiotics, depending on the original province where the visit is performed. There exists diagnostic and treatment variability, as compared to guidelines, regarding over prescription of antibiotics and steroidal drugs. There also exists treatment variability between the different provinces. These factors may result in unequal services rendering.