CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France; Centre Inserm U1219 Bordeaux Population Health, université de Bordeaux, ISPED, 33076 Bordeaux, France; Inserm, ISPED, centre Inserm U1219 Bordeaux Population Health, 33076 Bordeaux, France.
CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France; Centre Inserm U1219 Bordeaux Population Health, université de Bordeaux, ISPED, 33076 Bordeaux, France; Inserm, ISPED, centre Inserm U1219 Bordeaux Population Health, 33076 Bordeaux, France.
Arch Cardiovasc Dis. 2018 Mar;111(3):155-171. doi: 10.1016/j.acvd.2017.05.005. Epub 2017 Sep 21.
Indicators of the appropriateness of oral anticoagulant prescriptions are lacking, despite the major contribution they could make to improve quality of care.
To identify and select such indicators according to their utility and operational implementation.
A literature review was conducted to identify indicators of the appropriateness of oral anticoagulant prescriptions according to the guidelines of health authorities and European learned societies. A first list of indicators was identified from guidelines related to general or targeted clinical situations. A two-round Delphi consensus process, completed by a synthesis meeting, was then set up to ask European experts to rate the utility and operational implementation of the indicators on a qualitative binary scale. An indicator was selected if ≥80% of the experts judged it both useful and implementable (strong consensus).
We selected 32 references, from which 84 indicators were identified. Nineteen indicators were short-listed for submission to expert judgment. Twenty-two experts participated in the Delphi process. Sixteen indicators obtained strong consensus for selection; three indicators did not achieve consensus. Two-thirds of the selected indicators focused on the appropriateness of oral anticoagulant prescriptions in general or in patients with atrial fibrillation; the other third focused on the appropriateness of prescriptions in patients with a prosthetic heart valve, venous thromboembolism or trauma.
This work addresses the current lack of indicators of the appropriateness of oral anticoagulant prescriptions. The selected indicators will be implemented from the hospital information system to assess their metrological properties to detect inappropriate prescriptions.
尽管口服抗凝药物处方的适宜性指标可以极大地促进医疗质量的提升，但目前此类指标仍十分匮乏。
根据实用性和操作性，确定并选择此类指标。
我们按照卫生部门和欧洲学术学会的指南，对口服抗凝药物处方适宜性的指标进行了文献回顾。我们首先从与一般或特定临床情况相关的指南中确定了一系列指标。然后，通过两轮德尔菲共识程序（并附有一次总结会议），请欧洲专家对指标的实用性和操作性进行定性二分法评分。如果≥80%的专家认为该指标既实用又可操作，则选择该指标（强共识）。
我们共查阅了 32 篇参考文献，从中确定了 84 个指标。19 个指标被列入专家判断的短名单。22 名专家参与了德尔菲调查。有 16 个指标获得了选择的强共识；有 3 个指标未达成共识。三分之二的入选指标关注一般或心房颤动患者口服抗凝药物处方的适宜性；其余三分之一的指标则关注人工心脏瓣膜、静脉血栓栓塞或创伤患者的处方适宜性。
本研究针对目前口服抗凝药物处方适宜性指标的缺乏问题，选择了一些适宜性指标，将从医院信息系统中进行实施，以评估其计量学特性，从而发现不适当的处方。
