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

Abstract

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.

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

“…optimal practice is not achieved in many hospitals. 4,[8][9][10] In this study, the practice of thoracic surgeons in Iran is fairly consistent with ASHP guidelines in terms of prescribing SAP. This finding is in accordance with a previous report in which a questionnaire was used to evaluate the knowledge, attitude and practice of thoracic surgeons.…”

“…Evidence for the effectiveness of SAP prescription is well established. Nevertheless, some studies suggest that optimal practice is not achieved in many hospitals . In this study, the practice of thoracic surgeons in Iran is fairly consistent with ASHP guidelines in terms of prescribing SAP.…”

The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines

“…Bos et al introduced an educational program for prescribers in the hospital combined with audit and feedback by the hospital pharmacist. This led to a significant decrease in non-adherence from 30.5 to 21.8% of prescribing physicians to key pharmacotherapeutic guidelines, such as gastric protection in case of use of NSAID in hospitalized surgical patients and perioperative bridging of antithrombotics [ 14 ]. Other multifaceted intervention studies focusing on antibiotics found an increase in the rate of guideline adherence of antibiotic prescription [ 27 , 28 ].…”

“…Education programs together with computer-based clinical decision support systems showed significant improvements in adherence to guidelines for venous thromboembolism in hospitals [ 13 ]. Bos et al [ 14 ] showed that education of hospital prescribers combined with audit and feedback by hospital pharmacists reduced physician non-adherence to guidelines covering pain management, antithrombotics, fluid and electrolyte management, application of radiographic contrast agents and surgical antibiotic prophylaxis. Furthermore, Maynard and colleagues evaluated the impact of the implementation of a multidisciplinary team on inpatient anticoagulation and management of venous thromboembolism in 189 patients with 211 identified VTE events [ 15 ].…”

Impact of pharmaceutical care in the orthopaedic department

“…If pharmacists educate inpatients about not only the benefits but also the potential side effects of their medications, as well as on drug use and therapeutic goals, then their improved knowledge, attitude and practice helps to reduce ADEs following discharge . In addition, a study in Dutch hospitals by Bos et al showed how the combination of an educational programme and medication counselling for prescribing physicians on surgical, urological and orthopaedic wards led to a significant reduction (from 30.5% [332/1089] to 21.8% [193/886], P < .05) in non‐adherence to guidelines, and this effect was strengthened by a weekly visit from the hospital pharmacist . For patients, personalized educational material is called for, containing information on possible adverse reactions and the measures to take to avoid them, why the medication may be inappropriate, potential alternative treatment options, etc A 2018 randomized clinical trial found that 75% of sedative‐hypnotic drug users successfully completed a tapering protocol compared with 54% in a 2014 trial examining the effect of patient education alone on reducing inappropriate prescriptions .…”