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Type: Journal article
Title: Impact of introducing anticoagulation-related prescribing guidelines in a hospital setting using academic detailing
Author: Roberts, G.
Adams, R.
Citation: Therapeutics and Clinical Risk Management, 2006; 2(3):309-316
Publisher: Dove Medical Press Ltd.
Issue Date: 2006
ISSN: 1176-6336
Statement of
Gregory William Roberts and Robert Adams
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 preexisting 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.
Keywords: warfarin; overanticoagulation; DVT prophylaxis; elderly; academic detailing
Description: Copyright 2006 DOVE Medical Press Ltd. All rights reserved.
RMID: 0020071561
DOI: 10.2147/tcrm.2006.2.3.309
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Appears in Collections:Medicine publications

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