The ACCP recommends that physicians be given hospital-specific data demonstrating the potential benefits of prophylactic strategies and that they be involved in educational programs, to motivate them to use such strategies. Despite the employment of these recommendations in educational interventions at the authors’ institution, rates of prophylaxis remained poor. Previous studies have found that didactic education, printed continuing education materials, conferences, and mailings are all weak tools for implementing change when used alone. To be successful, educational strategies must incorporate methods that continuously reinforce change, such as automated reminder systems (e.g., preprinted order sheets), academic detailing, and concurrent and retrospective feedback. Furthermore, multiple interventions are more effective than any single approach.
Several studies have highlighted underuse of VTE prophylaxis in medical patients and have indicated that only about one-third of eligible medical patients receive VTE prophylaxis upon admission to hospital (Table 5). The reasons for underuse may relate to uncertainty about optimal use of VTE prophylaxis in a clinical setting, including patient selection, optimal time to assess the need for VTE prophylaxis, appropriate type of VTE prophylaxis, and appropriate duration of therapy. However, because CHF and COPD have been identified as independent risk factors for VTE, there should be a greater appreciation of the need for prophylaxis in patients with these conditions. Only one other study has assessed a patient population similar to the one studied here; in that study, the rate of prophylaxis was also poor, but no educational intervention was undertaken. In another study that did involve an educational intervention, the rates improved significantly because orders for VTE prophylaxis were added to preprinted orders.
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Table 5. Other Clinical Trials Illustrating Underutilization of VTE Prophylaxis in Medical Patients
The limitations of this study include the retrospective nature of the analysis, the limited sample size, and the short follow-up period. The methods used to determine the rates of VTE prophylaxis in the initial audit did not correspond to those used in the retrospective analysis; therefore, direct comparisons of these 2 data sets are not possible. In addition, this study included only medical patients with CHF or COPD and thus might not reflect VTE prophylaxis rates for all general medical patients at the authors’ institution.
VTE prophylaxis was underused for medical patients with CHF or COPD exacerbation at the authors’ institution, and educational interventions alone were insufficient to ensure routine use of prophylaxis in clinical practice. After completion of this study, VTE prophylaxis was added to preprinted order sheets for patients admitted with CHF or COPD exacerbations, to ensure that these patients are considered for appropriate VTE prophylaxis.