Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing
Background. Anticoagulants (AC) are the high-risk drugs. Their safety closely depends on physician’s compliance with clinical practice guidelines (CPG) and summary of product characteristics (SmPC).Aim. To analyze the physician’s compliance with CPG and SmPC for AC prescribing for patients with atri...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Столичная издательская компания
2018-09-01
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| Series: | Рациональная фармакотерапия в кардиологии |
| Subjects: | |
| Online Access: | https://www.rpcardio.online/jour/article/view/1718 |
| _version_ | 1797232182782066688 |
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| author | A. A. Chernov E. V. Kleymenova D. A. Sychev L. P. Yashina M. D. Nigmatkulova V. A. Otdelenov S. A. Payushchik |
| author_facet | A. A. Chernov E. V. Kleymenova D. A. Sychev L. P. Yashina M. D. Nigmatkulova V. A. Otdelenov S. A. Payushchik |
| author_sort | A. A. Chernov |
| collection | DOAJ |
| description | Background. Anticoagulants (AC) are the high-risk drugs. Their safety closely depends on physician’s compliance with clinical practice guidelines (CPG) and summary of product characteristics (SmPC).Aim. To analyze the physician’s compliance with CPG and SmPC for AC prescribing for patients with atrial fibrillation (AF) and deep vein thrombosis (DVT).Material and methods. The study comprised a retrospective review of electronic medical records (EMR) for 50 patients with AF and 50 patients with DVT admitted to general hospital in Moscow during the 2016-2017 period. Via clinical decision support system (CDSS) actual AC prescriptions in EMR were compared with recommendations from relevant CPG and SmPC to analyze deviations in AC indications/contraindications and dosing.Results. ACs were prescribed for 43 (86%) AF patients, including warfarin (39.5%), direct oral anticoagulants (DOAC) (46.5%) and low-molecular weight heparin (LMWH) (14%). The structure of AC in-hospital therapy for DVT patients (excluding initial therapy) was the following: 39.5% DOAC, 33.5% LMWH and 27% warfarin. The cumulative rate of physician’s compliance with AC prescribing recommendations for AF/DVT patients was 88%. The rate of adverse drug events (ADE) in «non-adherent» group was significantly higher than in «adherent» one (34% vs 11%, respectively, OR=3.9; 95%CI 0.9-15.3; p=0.045). Cumulative compliance with AC dosing recommendations was 63.5 %. In «non-adherent» group direct cost for inpatient AC therapy was significantly higher than in «adherent» group 4041 rubles (interquartile range, IQR=7501 rubles) vs 1134 rubles (IQR=5911 rubles), respectively; p=0.02.Conclusion. Physician’s noncompliance with CPG and SmPC can increase the risk of ADE and direct costs of AC therapy. The CDSS can be a useful tool both for clinical audit and for improving physician’s adherence to recommended AC therapy. |
| first_indexed | 2024-03-08T14:02:27Z |
| format | Article |
| id | doaj.art-bf45ff703ad24a368648b9e67ce0529a |
| institution | Directory Open Access Journal |
| issn | 1819-6446 2225-3653 |
| language | English |
| last_indexed | 2024-04-24T15:56:13Z |
| publishDate | 2018-09-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj.art-bf45ff703ad24a368648b9e67ce0529a2024-04-01T07:43:36ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532018-09-0114450150810.20996/1819-6446-2018-14-4-501-5081500Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant PrescribingA. A. Chernov0E. V. Kleymenova1D. A. Sychev2L. P. Yashina3M. D. Nigmatkulova4V. A. Otdelenov5S. A. Payushchik6General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesRussian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of SciencesGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationGeneral Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional EducationBackground. Anticoagulants (AC) are the high-risk drugs. Their safety closely depends on physician’s compliance with clinical practice guidelines (CPG) and summary of product characteristics (SmPC).Aim. To analyze the physician’s compliance with CPG and SmPC for AC prescribing for patients with atrial fibrillation (AF) and deep vein thrombosis (DVT).Material and methods. The study comprised a retrospective review of electronic medical records (EMR) for 50 patients with AF and 50 patients with DVT admitted to general hospital in Moscow during the 2016-2017 period. Via clinical decision support system (CDSS) actual AC prescriptions in EMR were compared with recommendations from relevant CPG and SmPC to analyze deviations in AC indications/contraindications and dosing.Results. ACs were prescribed for 43 (86%) AF patients, including warfarin (39.5%), direct oral anticoagulants (DOAC) (46.5%) and low-molecular weight heparin (LMWH) (14%). The structure of AC in-hospital therapy for DVT patients (excluding initial therapy) was the following: 39.5% DOAC, 33.5% LMWH and 27% warfarin. The cumulative rate of physician’s compliance with AC prescribing recommendations for AF/DVT patients was 88%. The rate of adverse drug events (ADE) in «non-adherent» group was significantly higher than in «adherent» one (34% vs 11%, respectively, OR=3.9; 95%CI 0.9-15.3; p=0.045). Cumulative compliance with AC dosing recommendations was 63.5 %. In «non-adherent» group direct cost for inpatient AC therapy was significantly higher than in «adherent» group 4041 rubles (interquartile range, IQR=7501 rubles) vs 1134 rubles (IQR=5911 rubles), respectively; p=0.02.Conclusion. Physician’s noncompliance with CPG and SmPC can increase the risk of ADE and direct costs of AC therapy. The CDSS can be a useful tool both for clinical audit and for improving physician’s adherence to recommended AC therapy.https://www.rpcardio.online/jour/article/view/1718anticoagulantsatrial fibrillationdeep vein thrombosisadverse drug eventsclinical guidelines adherence |
| spellingShingle | A. A. Chernov E. V. Kleymenova D. A. Sychev L. P. Yashina M. D. Nigmatkulova V. A. Otdelenov S. A. Payushchik Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing Рациональная фармакотерапия в кардиологии anticoagulants atrial fibrillation deep vein thrombosis adverse drug events clinical guidelines adherence |
| title | Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing |
| title_full | Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing |
| title_fullStr | Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing |
| title_full_unstemmed | Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing |
| title_short | Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing |
| title_sort | physician s adherence to clinical guidelines for in hospital anticoagulant prescribing |
| topic | anticoagulants atrial fibrillation deep vein thrombosis adverse drug events clinical guidelines adherence |
| url | https://www.rpcardio.online/jour/article/view/1718 |
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