Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study
Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study
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DOI：
10.1007/s005200100273
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发表时间：
2001-11-01
影响因子：
3.1
通讯作者：
Warr, D
中科院分区：
文献类型：
--
作者：
Dranitsaris, G;Leung, P;Warr, D
在随机试验中获得的结果和将其付诸实践之间存在相当大的差距。这与高成本的5 HT 3止吐药特别相关，包括昂丹司琼、多拉司琼和格拉司琼。随机试验数据表明，它们应该在化疗的前24小时内作为单次每日剂量使用，因为在此期间之后，它们提供的益处比成本较低的药物少。在这项研究中，六种干预方法（即多方面的方法）相结合，以改变医生的5 HT 3处方模式，以符合循证止吐指南。通过了一个六步骤的实施过程，包括指导方针的传播，舆论领袖的使用，互动式教育讲习班，治疗提醒的形式预先打印的订单，由药剂师的临床干预的情况下，不适当的止吐订单，医生审计和反馈。一旦实施，收集所有参与干预计划的患者的呕吐控制情况。然后采用多变量回归分析评估止吐指南内的处方是否损害了患者的护理。在4个月的干预期内，共有195名住院患者入组研究。总体而言，88.7%的格拉司琼处方符合关于适当适应症、剂量和治疗持续时间的指南。多变量分析表明，格拉司琼处方内的指南并不影响控制急性和迟发性呕吐。此外，接受循证止吐治疗的患者急性恶心的严重程度显著降低[风险比（RR）= 0.69; P=0.03]。该指南实施研究的结果表明，针对5 HT 3止吐药等高成本药物的药剂师驱动的多方面干预计划可以促进其以临床适当的方式使用，并可以节省不必要的药物成本，而不会影响患者护理质量。
There is a considerable gap between obtaining results in randomized trials and implementing them into practice. This is particularly relevant with the high-cost 5HT3 antiemetics, which include ondansetron, dolasetron and granisetron. Randomized trial data suggests that they should be used as a single daily dose during only the first 24 h of chemotherapy because they offer little benefit over less costly agents beyond this period. In this study, six intervention methods (i.e. multifaceted approach) were combined to change physicians' 5HT3 prescribing patterns to comply with evidence-based antiemetic guidelines. A six-step implementation process was adopted, consisting of guideline dissemination, the use of opinion leaders, interactive educational workshops, therapeutic reminders in the form of preprinted orders, clinical interventions by pharmacists for the event of inappropriate antiemetic orders, and physician audit and feedback. Once implemented, the control of emesis was collected in all patients who were enrolled in the intervention program. Multivariable regression analysis was then used to assess whether prescribing within antiemetic guidelines compromised patient care. A total of 195 inpatients were enrolled in the study over the 4-month intervention period. Overall, 88.7% of granisetron prescriptions fulfilled the guidelines with respect to appropriate indication, dosage, and duration of therapy. The multivariable analysis suggested that granisetron prescribing within guidelines did not compromise the control of acute and delayed emesis. In addition, patients who received evidence-based antiemetic therapy experienced a significant reduction in the severity of acute nausea [risk ratio (RR) = 0.69; P=0.03]. The results of this guideline implementation study revealed that a pharmacist-driven multifaceted intervention program for such high-cost agents as 5HT3 antiemetics can promote their use in a clinically appropriate manner and can save unnecessary drug costs without compromising the quality of patient care.