菲律宾马尼拉大都会两家三级公立医院中医生对新冠肺炎患者当地指南建议的遵循情况：一项快速评估研究
Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public Hospitals in Metro Manila, Philippines: A Rapid Assessment Study.
作者信息
Elepaño Anton G, Cordero Cynthia P, Palileo-Villanueva Lia M, Castillo-Carandang Nina T Nina T, Abola Maria Teresa B, Borbe Jan Bendric C, Tang Vincent Anthony S, Mapili Jerahmeel Aleson L, Elvambuena Bryan F, Velasco Rogelio N, Padua Leahdette O, Arenos Carl Lawrence C, Dans Leonila F, Dans Antonio Miguel L
机构信息
Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila.
出版信息
Acta Med Philipp. 2023 Nov 24;57(11):34-40. doi: 10.47895/amp.vi0.6256. eCollection 2023.
OBJECTIVES
Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19.
METHODS
This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed.
RESULTS
A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given.
CONCLUSION
Management of COVID-19 in both centers was generally adherent to guideline recommendations. We detected high underuse of tocilizumab probably related to the global supply shortage during the study period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies.
目的
遵循临床实践指南（CPG）已被证明可减少医生之间的实践差异并提高医疗质量。本研究评估了两家三级公立医院的医生对当地COVID-19临床实践指南的遵循情况。
方法
这是一项多中心、回顾性病历审查的快速评估方法研究。在2021年7月至10月期间，对两个中心收治的患者样本中，针对现行菲律宾COVID-19生存指南中15项强烈推荐的指南遵循情况及不遵循情况（过度使用和使用不足）进行了评估。分析了不同COVID-19疾病严重程度和管理医院科室之间遵循情况的差异。
结果
共审查了来自两个中心的723份患者病历。低氧血症患者使用地塞米松的指南遵循率为91.4%（95%置信区间88.6至93.6），过度使用率为9.2%。52.2%有指征接受托珠单抗治疗的患者存在使用不足。43.6%无细菌合并感染怀疑的患者存在经验性抗生素过度使用情况。在病情严重的患者和重症监护病房管理的患者中，抗生素使用的遵循率最低。未给予其他任何未推荐的治疗方式。
结论
两个中心的COVID-19管理总体上遵循指南推荐。我们发现托珠单抗使用率极低，可能与研究期间全球供应短缺有关，而在无细菌合并感染怀疑的患者中抗生素过度使用率很高。虽然本研究结果不能推广到其他医疗环境，但我们建议在指南遵循评估中应用类似的快速评估研究作为质量改进工具，并识别资源利用方面的问题，尤其是在突发公共卫生事件期间。
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