| Title |
A physician targeted intervention improves prescribing in chronic heart failure in general medical units
|
|---|---|
| Published in |
BMC Health Services Research, March 2018
|
| DOI | 10.1186/s12913-018-3009-x |
| Pubmed ID | |
| Authors |
Chong Chyn Chua, Anastasia Hutchinson, Mark Tacey, Sumit Parikh, Wen Kwang Lim, Craig Aboltins |
| Abstract |
Despite strong evidence for beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in chronic heart failure (CHF), they have been under-utilised especially in general medical units. We aim to evaluate the effectiveness and feasibility of a physician-targeted quality improvement intervention with education and feedback on the prescription of beta-blockers and ACEI/ARB for CHF management in an inpatient setting. We conducted an interrupted time series study between January 2009 and February 2012. A two-stage intervention was implemented. Between November 2009 and January 2011, a structured physician-oriented education program was undertaken. From February 2011, quarterly performance feedback was provided to each medical unit by a senior clinician. Medical notes of patients admitted with CHF under general medical units before and during the intervention were prospectively audited. Main outcomes were beta-blockers and ACEI/ARB prescription rates, and 180-day readmission rates for CHF. Four hundred and sixty-eight patients were included in this study. Structured education program was associated with a significant rise in beta-blockers prescription rates from a baseline of 60 to 92% (p = 0.003), but a non-sustained rise in ACEI/ARB prescription. Regular performance feedback resulted in a further sustained increase in ACEI/ARB prescription rates from 62 to 93% (p = 0.028) and a positive trend for beta-blockers with rates maintained at 89%. There was a reduction in 180-day readmission rates that correlated with the improvements in beta-blocker (p = 0.030) and ACEI/ARB (p = 0.035) prescription. Implementation of a structured education program with regular performance feedback was durable and was associated with improvements in appropriate prescribing and an observed decrease in CHF-related readmissions. |
X Demographics
The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 1 | 33% |
| Unknown | 2 | 67% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 33% |
| Scientists | 1 | 33% |
| Practitioners (doctors, other healthcare professionals) | 1 | 33% |
Mendeley readers
The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 40 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 6 | 15% |
| Student > Master | 5 | 13% |
| Student > Ph. D. Student | 5 | 13% |
| Student > Doctoral Student | 3 | 8% |
| Other | 3 | 8% |
| Other | 3 | 8% |
| Unknown | 15 | 38% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 8 | 20% |
| Nursing and Health Professions | 7 | 18% |
| Pharmacology, Toxicology and Pharmaceutical Science | 3 | 8% |
| Psychology | 1 | 3% |
| Business, Management and Accounting | 1 | 3% |
| Other | 2 | 5% |
| Unknown | 18 | 45% |
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 March 2018.
All research outputs
#15,557,505
of 23,881,329 outputs
Outputs from BMC Health Services Research
#5,622
of 7,949 outputs
Outputs of similar age
#203,943
of 333,512 outputs
Outputs of similar age from BMC Health Services Research
#156
of 210 outputs
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