Ther Clin Risk Manag. 2006 Sep;2(3):309-16. doi: 10.2147/tcrm.2006.2.3.309.
Assess the impact of using academic detailing-assisted guideline roll-out on warfarin initiation, reversal of warfarin overanticoagulation, and uptake of deep vein thrombosis (DVT) prophylaxis across 4 metropolitan teaching hospitals.
Baseline data were collected for 3 months prior to intervention. Prescribers were then informed about the guidelines, including feedback of current hospital performance and the basis for the guidelines. Post-intervention data were collected for 3 months after guideline implementation.
Uptake of DVT prophylaxis in medical patients increased from 52.8% to 67.0% (p=0.004). No impact on operative surgical patients was seen, possibly due to the high pre-existing rate of uptake (86.1% vs 84.1%, p=0.7). DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements. The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR's >4 in the first week of therapy (p=0.03). There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR's being less than 4 (49% vs 61%, p=0.04).
The use of academic detailing to facilitate guideline roll-out had a positive impact on nearly all areas studied. The academic detailing process within the hospital setting was received enthusiastically by prescribers.
评估在 4 家都市教学医院中，使用学术细化辅助指南推出对华法林起始、华法林过度抗凝逆转以及深静脉血栓形成（DVT）预防的影响。
在干预前收集了 3 个月的基线数据。然后，向医生通报了指南，包括当前医院绩效的反馈和指南的依据。在指南实施后的 3 个月内收集了后续数据。
内科患者的 DVT 预防使用率从 52.8%增加到 67.0%（p=0.004）。在手术患者中没有看到影响，这可能是由于预先存在的高使用率（86.1%比 84.1%，p=0.7）。非手术手术患者的 DVT 预防率与内科患者相似，虽然有所改善，但无统计学意义。华法林起始后达到稳定治疗国际标准化比值（INR）的时间缩短（p=0.03），治疗第 1 周 INR>4 的次数减少（p=0.03）。对于 INR>6 的华法林过度抗凝患者，适当使用维生素 K 的情况有所改善（48%比 74%，p=0.007），及时进行后续检测（49%比 62%，p=0.009），以及下一个 INR 值小于 4 的比例（49%比 61%，p=0.04）。
使用学术细化来促进指南的推出对华法林起始、华法林过度抗凝逆转以及 DVT 预防的几乎所有研究领域都产生了积极影响。医院环境中的学术细化过程受到了医生的热烈欢迎。
