A physician targeted intervention improves prescribing in chronic heart failure in general medical units
AuthorChua, CC; Hutchinson, A; Tacey, M; Parikh, S; Lim, WK; Aboltins, C
Source TitleBMC Health Services Research
PublisherBIOMED CENTRAL LTD
AffiliationMedicine and Radiology
Melbourne School of Population and Global Health
Document TypeJournal Article
CitationsChua, C. C., Hutchinson, A., Tacey, M., Parikh, S., Lim, W. K. & Aboltins, C. (2018). A physician targeted intervention improves prescribing in chronic heart failure in general medical units. BMC HEALTH SERVICES RESEARCH, 18 (1), https://doi.org/10.1186/s12913-018-3009-x.
Access StatusOpen Access
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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