A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals.

Background Despite the potential of clinical practice guidelines to improve patient outcomes, adherence to guidelines by prescribers is inconsistent. Objective The aim of the study was to determine whether an approach of introducing an educational programme for prescribers in the hospital combined with audit and feedback by the hospital pharmacist reduces non-adherence of prescribing physicians to key pharmacotherapeutic guidelines. Setting This prospective intervention study with a before-after design evaluated patients at surgical, urological and orthopaedic wards. Method An educational program covering pain management, antithrombotics, fluid and electrolyte management, prescribing in case of renal insufficiency, application of radiographic contrast agents and surgical antibiotic prophylaxis was presented to prescribers on the participating wards. Hospital pharmacists performed medication safety consultations, combining medication review of patients who are at risk for drug related problems with visits to ward physicians. Main outcome measure The outcome measure was the proportion of the admissions of patients in which the physician did not adhere to one or more of the included guidelines. Difference was expressed in odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was performed. Results 1435 Admissions of 1378 patients during the usual care period and 1195 admissions of 1090 patients during the intervention period were included. Non-adherence was observed significantly less often during the intervention period [21.8% (193/886)] as compared to the usual care period [30.5% (332/1089)]. The adjusted OR was 0.61 (95% CI 0.49-0.76). Conclusion This study shows that education and support of the prescribing physician can reduce guideline non-adherence at surgical wards.

A multifaceted intervention to reduce drug-related complications in surgical patients.

AIM: The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. METHODS: A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. RESULTS: A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P = 0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. CONCLUSIONS: The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.

The evaluation of an intervention based on the application of patient self-completion concordance forms in Dutch community pharmacies and the effect on adherence to chronic medication.

OBJECTIVE: To evaluate the use of patient self-completion concordance forms and to determine the effect of patient counselling by using concordance forms on adherence to chronic medication. METHODS: Patients with a prescription for new chronic treatment were randomised in an intervention or control group. The intervention group received a concordance form to fill in at home and to discuss during a consultation 2 weeks later in the pharmacy. The control group received the usual information and instruction on how to use the medicine. Afterwards, all patients were asked to fill in a questionnaire about their use of medicines and contact with the pharmacy employees. Adherence to the medicine was determined using rates of prescription refills after 6 months of use. RESULTS: The questionnaires showed that patients were satisfied about the concordance model. After 6 months of use, 79% of the patients from both intervention and control group were defined as adherent. CONCLUSIONS: There was no significant difference found in adherence between intervention and control group. PRACTICE IMPLICATIONS: Use five selected questions from the concordance form which provided most answers. Focus on one drug group and have more consultation moments.