Prevention of Venous Thromboembolism in Long Term Care: Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project)

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• 作者：T.S. Dharmarajan ; MD ; ^{dharmarajants@yahoo.com} ; Aman Nanda ; MD ; Bikash Agarwal ; MD ; Parag Agnihotri ; MD ; G.L. Doxsie ; GNP ; Murthy Gokula ; MD ; Ashkan Javaheri ; MD ; M. Kanagala ; MD ; Anna S. Lebelt ; MD ; Prasuna Madireddy ; MD ; Sourya Mahapatra ; MD ; P. Murakonda ; MD ; S. Ram Rao Muthavarapu ; MD ; Mennakshi Patel ; MD ; Christopher Patterson ; MD ; Kathleen Soch ; MD ; Anna Troncales ; MD ; Kamal Yaokim ; MD ; Robin Kroft ; PhD ; Edward P. Norkus ; PhD
• 关键词：Venous thromboembolism ; DVT ; VTE prophylaxis ; pulmonary embolism ; mechanical measures to prevent VTE ; venous thromboembolism prophylaxis in LTC
• 刊名：Journal of the American Medical Directors Association
• 出版年：2012
• 出版时间：March, 2012
• 年：2012
• 卷：13
• 期：3
• 页码：303-307
• 全文大小：131 K

文摘

Introduction

Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs.

Methods

Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers.

Results

The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P > .05). In Phase 3, use of aspirin alone decreased more than 50 % (P < .0005), whereas use of compression devices increased (P < .0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P > .05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P?= .022 to P < .0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P.

Conclusions

The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P.