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Impact of Introducing Anticoagulation-Related Prescribing Guidelines in a Hospital Setting using Academic Detailing.

Roberts GW, Adams R - Ther Clin Risk Manag (2006)

Bottom Line: DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements.The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR's >4 in the first week of therapy (p=0.03).There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR's being less than 4 (49% vs 61%, p=0.04).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: Assess the impact of using academic detailing-assisted guideline roll-out on warfarin initiation, reversal of warfarin overanticoagulation, and uptake of deep vein thrombosis (DVT) prophylaxis across 4 metropolitan teaching hospitals.

Methods: Baseline data were collected for 3 months prior to intervention. Prescribers were then informed about the guidelines, including feedback of current hospital performance and the basis for the guidelines. Post-intervention data were collected for 3 months after guideline implementation.

Results: Uptake of DVT prophylaxis in medical patients increased from 52.8% to 67.0% (p=0.004). No impact on operative surgical patients was seen, possibly due to the high pre-existing rate of uptake (86.1% vs 84.1%, p=0.7). DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements. The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR's >4 in the first week of therapy (p=0.03). There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR's being less than 4 (49% vs 61%, p=0.04).

Conclusions: The use of academic detailing to facilitate guideline roll-out had a positive impact on nearly all areas studied. The academic detailing process within the hospital setting was received enthusiastically by prescribers.

No MeSH data available.


Related in: MedlinePlus

DVT prophylaxis outcomes (p<0.01).Abbreviations: DVT, deep vein thrombosis; GFR, glomerular filtration rate.
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fig1: DVT prophylaxis outcomes (p<0.01).Abbreviations: DVT, deep vein thrombosis; GFR, glomerular filtration rate.

Mentions: During the pre-intervention period 198 patients were identified as being eligible for DVT prophylaxis, including 26 patients admitted under surgical teams for medical reasons. Of these, 180 patients had no obvious contra-indication for DVT prophylaxis and were not on oral anticoagulants, with 52.8% receiving DVT prophylaxis. There were 266 patients assessed post-intervention, 49 of who were admitted under surgical teams. Of these, 230 patients had no obvious contra-indication for DVT prophylaxis and were not on oral anticoagulants, with 67.0% receiving DVT prophylaxis, an absolute increase of 14.2% (p=0.004) (Figure 1).


Impact of Introducing Anticoagulation-Related Prescribing Guidelines in a Hospital Setting using Academic Detailing.

Roberts GW, Adams R - Ther Clin Risk Manag (2006)

DVT prophylaxis outcomes (p<0.01).Abbreviations: DVT, deep vein thrombosis; GFR, glomerular filtration rate.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1936267&req=5

fig1: DVT prophylaxis outcomes (p<0.01).Abbreviations: DVT, deep vein thrombosis; GFR, glomerular filtration rate.
Mentions: During the pre-intervention period 198 patients were identified as being eligible for DVT prophylaxis, including 26 patients admitted under surgical teams for medical reasons. Of these, 180 patients had no obvious contra-indication for DVT prophylaxis and were not on oral anticoagulants, with 52.8% receiving DVT prophylaxis. There were 266 patients assessed post-intervention, 49 of who were admitted under surgical teams. Of these, 230 patients had no obvious contra-indication for DVT prophylaxis and were not on oral anticoagulants, with 67.0% receiving DVT prophylaxis, an absolute increase of 14.2% (p=0.004) (Figure 1).

Bottom Line: DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements.The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR's >4 in the first week of therapy (p=0.03).There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR's being less than 4 (49% vs 61%, p=0.04).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: Assess the impact of using academic detailing-assisted guideline roll-out on warfarin initiation, reversal of warfarin overanticoagulation, and uptake of deep vein thrombosis (DVT) prophylaxis across 4 metropolitan teaching hospitals.

Methods: Baseline data were collected for 3 months prior to intervention. Prescribers were then informed about the guidelines, including feedback of current hospital performance and the basis for the guidelines. Post-intervention data were collected for 3 months after guideline implementation.

Results: Uptake of DVT prophylaxis in medical patients increased from 52.8% to 67.0% (p=0.004). No impact on operative surgical patients was seen, possibly due to the high pre-existing rate of uptake (86.1% vs 84.1%, p=0.7). DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements. The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR's >4 in the first week of therapy (p=0.03). There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR's being less than 4 (49% vs 61%, p=0.04).

Conclusions: The use of academic detailing to facilitate guideline roll-out had a positive impact on nearly all areas studied. The academic detailing process within the hospital setting was received enthusiastically by prescribers.

No MeSH data available.


Related in: MedlinePlus