Liberman Joshua D, Whelan Chad T
University of Chicago Hospitals, Chicago, IL, USA.
J Gen Intern Med. 2006 May;21(5):498-500. doi: 10.1111/j.1525-1497.2006.00435.x.
Many inpatients receive stress ulcer prophylaxis (SUP) inappropriately. This indiscriminate usage increases costs and avoidable side-effects. Practice-based learning and improvement (PBLI) methodology may improve compliance with published guidelines.
To investigate the response of internal medicine residents to an educational intervention regarding SUP.
A prospective, pre and postintervention cohort study using an educational intervention based on PBLI.
Three groups of consecutively admitted patients (1 group preintervention and 2 groups postintervention) on the medicine ward at a University Hospital.
Rates of inappropriate SUP prescription and discharge with an inappropriate prescription.
One month after the intervention, inappropriate prophylaxis was significantly decreased (59% pre, 29% postintervention, P<.002). The rate of discharge with an inappropriate prescription also decreased, but was not significant (25% pre, 14% postintervention, P=.14). In the 6-month postintervention cohort, inappropriate SUP remained lower (59% pre, 33% postintervention, P<.007). The rate of discharge with an inappropriate prescription was also significantly lower (25% pre, 7% postintervention, P<.009).
Practice-based learning and improvement can improve compliance with published guidelines, and change practice patterns. After the intervention, both inappropriate prophylaxis and inappropriate prescriptions upon discharge were reduced. Importantly, the intervention was sustained, transmitted across academic years to a new class of interns who had not directly experienced the intervention.
许多住院患者接受应激性溃疡预防（SUP）的方式并不恰当。这种不加区分的使用增加了成本以及可避免的副作用。基于实践的学习与改进（PBLI）方法可能会提高对已发布指南的依从性。
调查内科住院医师对应激性溃疡预防方面教育干预的反应。
一项前瞻性、干预前后队列研究，采用基于PBLI的教育干预。
大学医院内科病房连续收治的三组患者（1组干预前，2组干预后）。
不恰当的SUP处方率以及出院时带有不恰当处方的情况。
干预后1个月，不恰当的预防措施显著减少（干预前59%，干预后29%，P<0.002）。出院时带有不恰当处方的比例也有所下降，但不显著（干预前25%，干预后14%，P=0.14）。在干预后的6个月队列中，不恰当的SUP仍然较低（干预前59%，干预后33%，P<0.007）。出院时带有不恰当处方的比例也显著降低（干预前25%，干预后7%，P<0.009）。
基于实践的学习与改进可以提高对已发布指南的依从性，并改变实践模式。干预后，不恰当的预防措施以及出院时的不恰当处方都减少了。重要的是，这种干预得以持续，跨学年传递给了未曾直接经历该干预的新一届实习生。
