Programa de Pós-Graduação em Ciências da Saúde Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil.
Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil.
J Bras Pneumol. 2020 Mar 20;46(4):e20180325. doi: 10.36416/1806-3756/e20180325. eCollection 2020.
This study aimed to assess the adequacy of venous thromboembolism (VTE) prophylaxis prescription after a protocol implementation.
This was a before-and-after study conducted in a tertiary care hospital in Rio Grande do Sul, Southern Brazil. Medical and surgical inpatients aged 18 years or older were assessed for VTE risk and subsequently for thromboprophylaxis adequacy, according to their risk. The evaluations occurred before and after the protocol strategy implementation; it consisted of an online platform to access the protocol, a public posting of the protocol diagram, clinical alerts on the medical staff TV, e-mail alerts, and pop-up alerts on the computerized physician order entry system. The main outcome measure was the adequacy of VTE prophylaxis prescription according to the protocol.
A total of 429 patients were evaluated for thromboprophylaxis adequacy (213 before and 216 after). The prevalence of adequacy increased from 54% to 63% (pre and post-intervention, respectively), and after adjustment for patient type and phase of the study, the prevalence ratio reached (PR)=1.20, 95% confidence interval (CI) 1.02-1.42.
The results showed that the overall appropriateness of thromboprophylaxis prescription was weakly improved. Despite these results, this study provides evidence to date a bunch of strategies for protocol implementations in private institutions in middle-income countries with an open medical staff, as there are few studies investigating these simple and pragmatic interventions.
本研究旨在评估方案实施后静脉血栓栓塞症（VTE）预防用药的充分性。
这是巴西南里奥格兰德州一家三级保健医院进行的一项前后对照研究。对年龄在 18 岁及以上的内科和外科住院患者进行 VTE 风险评估，随后根据风险评估进行适当的血栓预防治疗。评估在方案策略实施前后进行；方案策略包括一个在线平台以获取方案、方案图的公开张贴、医护人员电视上的临床警示、电子邮件警示以及计算机医嘱输入系统上的弹出警示。主要结局指标是根据方案评估 VTE 预防用药的充分性。
共对 429 例患者进行了血栓预防用药充分性评估（干预前 213 例，干预后 216 例）。充分性的比例从 54%增加到 63%（分别为干预前和干预后），并且在校正患者类型和研究阶段后，患病率比达到 1.20（95%置信区间 1.02-1.42）。
结果表明，总体上血栓预防用药的适当性略有提高。尽管有这些结果，但这项研究提供了迄今为止在中高收入国家私立机构实施方案的一系列策略的证据，因为很少有研究调查这些简单而务实的干预措施。
