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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

The use of tetanus post-exposure prophylaxis guidelines by general practitioners and emergency departments in the Netherlands: a cross-sectional questionnaire study

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Robine Donken, Nicoline van der Maas, Corien Swaan, Tjerk Wiersma, Margreet te Wierik, Susan Hahné, Hester de Melker
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-112) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RD participated in the study design, data collection, data analysis and writing of the manuscript; HdM and NvdM were involved in the study design, data analysis and revision of the manuscript; CS, MtW and SH participated in the study design and revision of the manuscript; and TW contributed to the revision of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

The Dutch National Immunisation Programme includes six tetanus toxoid (TT) vaccinations and reaches a high rate of vaccination coverage. In the Netherlands, several guidelines related to tetanus post-exposure prophylaxis (T-PEP) are in place. In 2003, the Dutch Health Council (HC) reviewed the use of T-PEP. The aim of this study is to evaluate whether the HC recommendations have been implemented.

Methods

We asked 178 Dutch General Practitioner (GP) offices and 60 Emergency Departments (EDs) to participate in a cross-sectional questionnaire study and requested that participating facilities send in the T-PEP guidelines adopted by their practice. The differences, based on categories mentioned in the HC recommendations, between GPs and EDs and the type of T-PEP guidelines adopted were assessed.

Results

The response rates for the GPs and EDs were 38% (n = 67) and 70% (n = 42), respectively. 98% percent (n = 107) of the participants reported having T-PEP guidelines. Of the guidelines described in the survey responses, 28% (n = 23; EDs 41%, GPs 21%) were consistent with the HC-recommendations, 36% (n = 29; EDs 7%, GPs 52%) adhered to the guidelines of the College of GPs (CGP), which restricts the use of T-PEP to tetanus prone wounds but for these wounds is in line with the recommendations of the HC. The remaining 36% had adopted other guidelines, most of which can lead to over-prescription of T-PEP. Information on T-PEP was lacking in patients with higher risk vaccination histories.

Conclusion

Almost all participants have adopted T-PEP guidelines. Strict adherence to the HC recommendations is low. More than half of GPs have adopted the more restrictive CGP-guideline, which limits T-PEP to tetanus prone wounds.
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