Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Psychiatry, Columbia University Irving Medical Center and Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA.
J Subst Use Addict Treat. 2024 Nov;166:209485. doi: 10.1016/j.josat.2024.209485. Epub 2024 Aug 15.
Thiamine is the only therapy for prevention and treatment of Wernicke Encephalopathy among patients with Alcohol Use Disorder (AUD). Despite this fact, up to 75 % of inpatients with AUD are not prescribed thiamine during hospitalization. Even fewer patients are prescribed high-dose thiamine which many experts recommend should be standard of care. Previous attempts to improve thiamine prescribing for inpatients have had limited success.
We conducted an evaluation of thiamine prescribing in the year before and year after an intervention to increase high-dose thiamine prescribing. Pre-post study analysis occurred on two distinct study cohorts: those with alcohol-related diagnoses and those with elevated alcohol levels. The intervention was new electronic health record-based decision support which encouraged high-dose thiamine when any thiamine order was sought. No educational support was provided. The primary outcome was prescription of high-dose thiamine before versus after intervention. Of those with alcohol-related diagnoses, the monthly percentage of thiamine treatment courses including high-dose thiamine were graphed on a control chart.
We examined 5307 admissions with alcohol-related diagnoses (2285 pre- and 3022 post-intervention) and 698 admissions with elevated alcohol levels (319 pre- and 379 post-intervention). Among admissions with alcohol-related diagnoses, the intervention was associated with a higher proportion of admissions receiving high-dose thiamine prescriptions in the first 24 h (4.7 % vs. 1.1 %, adjusted odds ratio 4.50, CI 2.93 to 6.89, p < 0.001). A similar difference in high-dose thiamine was seen post-intervention among admissions with elevated alcohol levels (14.3 % vs. 2.5 %, adjusted odds ratio 6.43, CI 3.05 to 13.53, p < 0.001). The control chart among those with an alcohol-related diagnosis demonstrated special cause variation: the median percentage of thiamine treatment courses including high-dose thiamine improved from 8.2 % to 13.0 %.
Electronic decision support without educational interventions increased the use of high-dose thiamine among patients with alcohol-related diagnoses and with elevated alcohol levels during hospitalization. This increase occurred immediately in the month after the intervention and was sustained in the year-long study period after.
硫胺素是预防和治疗酒精使用障碍（AUD）患者中 Wernicke 脑病的唯一疗法。尽管如此，高达 75%的 AUD 住院患者在住院期间未开硫胺素。更少的患者被开了大剂量的硫胺素，而许多专家认为这应该是标准的治疗方法。以前试图改善住院患者的硫胺素开方，收效甚微。
我们对干预前后一年期间提高大剂量硫胺素开方的情况进行了硫胺素开方评估。预-后研究分析发生在两个不同的研究队列中：有酒精相关诊断的和有酒精水平升高的。干预措施是新的基于电子健康记录的决策支持，当任何硫胺素医嘱被寻求时，它鼓励开大剂量的硫胺素。没有提供教育支持。主要结果是干预前后开大剂量硫胺素的处方。对于有酒精相关诊断的患者，将包括大剂量硫胺素在内的硫胺素治疗疗程的每月百分比绘制在控制图上。
我们检查了 5307 例有酒精相关诊断的住院患者（2285 例干预前和 3022 例干预后）和 698 例有酒精水平升高的住院患者（319 例干预前和 379 例干预后）。在有酒精相关诊断的住院患者中，干预与更高比例的在 24 小时内接受大剂量硫胺素处方的住院患者相关（4.7%比 1.1%，调整后的优势比 4.50，95%置信区间 2.93 至 6.89，p<0.001）。在有酒精水平升高的住院患者中，干预后也观察到大剂量硫胺素的差异（14.3%比 2.5%，调整后的优势比 6.43，95%置信区间 3.05 至 13.53，p<0.001）。有酒精相关诊断的患者的控制图显示了特殊原因的变化：包括大剂量硫胺素在内的硫胺素治疗疗程的中位数百分比从 8.2%提高到 13.0%。
没有教育干预的电子决策支持增加了有酒精相关诊断和有酒精水平升高的住院患者的大剂量硫胺素的使用。这种增加在干预后的一个月内立即发生，并在一年的研究期内持续。
