ABSTRACT
OBJECTIVES: To evaluate the efficacy of an intervention on the practice of venous thromboembolism prevention. DESIGN: A multicenter, prospective, controlled, cluster-randomized, multifaceted intervention trial consisting of educational lectures, posters, and pocket cards reminding physicians of the guidelines for thromboprophylaxis use. SETTINGS: Twelve geriatric departments with 1861 beds total, of which 202, 803, and 856 in acute care, post-acute care, and long-term care wards, respectively. PARTICIPANTS: Patients hospitalized between January 1 and May 31, 2015, in participating departments. MEASUREMENTS: The primary endpoint was the overall adequacy of thromboprophylaxis prescription at the patient level, defined as a composite endpoint consisting of indication, regimen, and duration of treatment. Geriatric departments were divided into an intervention group (6 departments) and control group (6 departments). The preintervention period was 1 month to provide baseline practice levels, the intervention period 2 months, and the postintervention period 1 month in acute care and post-acute care wards or 2 months in long-term care wards. Multivariable regression was used to analyze factors associated with the composite outcome. RESULTS: We included 2962 patients (1426 preintervention and 1536 postintervention), with median age 85 [79;90] years. For the overall 18.9% rate of inadequate thromboprophylaxis, 11.1% was attributable to underuse and 7.9% overuse. Intervention effects were more apparent in post-acute and long-term care wards although not significantly [odds ratio 1.44 (95% confidence interval 0.78;2.66), P = .241; and 1.44 (0.68, 3.06), P = .345]. Adequacy rates significantly improved in the postintervention period for the intervention group overall (from 78.9% to 83.4%; P = .027) and in post-acute care (from 75.4% to 86.3%; P = .004) and long-term care (from 87.0% to 91.7%; P = .050) wards, with no significant trend observed in the control group. CONCLUSIONS/IMPLICATIONS: This study failed to demonstrate improvement in prophylaxis adequacy with our intervention. However, the intervention seemed to improve practices in post-acute and long-term care but not acute care wards.
Subject(s)
Anticoagulants/therapeutic use , Inpatients , Venous Thromboembolism/prevention & control , Aged , Aged, 80 and over , Female , France , Humans , Male , Outcome Assessment, Health Care , Prospective StudiesABSTRACT
Since the early 1999, palliative cares were legally allowed in France. The rights of end of life'patients have been reinforced by the Kouchner law in 2002 and by the Leonetti law in 2005. During the last decade, several critical conditions of end of life showed the weaknesses of the Leonetti law however different assessments of this law recently carried out by officials, revealed that healthcare providers and general population were unfamiliar with this law. Before adopting new legislation, there is a huge need to promote palliative care and to train healthcare providers and general population to manage the last moments of end of life.
