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Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing

https://doi.org/10.20996/1819-6446-2018-14-4-501-508

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Abstract

Background. Anticoagulants (AC) are the high-risk drugs. Their safety closely depends on physician’s compliance with clinical practice guidelines (CPG) and summary of product characteristics (SmPC).

Aim. To analyze the physician’s compliance with CPG and SmPC for AC prescribing for patients with atrial fibrillation (AF) and deep vein thrombosis (DVT).

Material and methods. The study comprised a retrospective review of electronic medical records (EMR) for 50 patients with AF and 50 patients with DVT admitted to general hospital in Moscow during the 2016-2017 period. Via clinical decision support system (CDSS) actual AC prescriptions in EMR were compared with recommendations from relevant CPG and SmPC to analyze deviations in AC indications/contraindications and dosing.

Results. ACs were prescribed for 43 (86%) AF patients, including warfarin (39.5%), direct oral anticoagulants (DOAC) (46.5%) and low-molecular weight heparin (LMWH) (14%). The structure of AC in-hospital therapy for DVT patients (excluding initial therapy) was the following: 39.5% DOAC, 33.5% LMWH and 27% warfarin. The cumulative rate of physician’s compliance with AC prescribing recommendations for AF/DVT patients was 88%. The rate of adverse drug events (ADE) in «non-adherent» group was significantly higher than in «adherent» one (34% vs 11%, respectively, OR=3.9; 95%CI 0.9-15.3; p=0.045). Cumulative compliance with AC dosing recommendations was 63.5 %. In «non-adherent» group direct cost for inpatient AC therapy was significantly higher than in «adherent» group 4041 rubles (interquartile range, IQR=7501 rubles) vs 1134 rubles (IQR=5911 rubles), respectively; p=0.02.

Conclusion. Physician’s noncompliance with CPG and SmPC can increase the risk of ADE and direct costs of AC therapy. The CDSS can be a useful tool both for clinical audit and for improving physician’s adherence to recommended AC therapy.

About the Authors

A. A. Chernov
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Anton A. Chernov – MD, Doctor, Department of Quality Management of Medical Care, General Medical Center of the Bank of Russia; Junior Researcher, Research Center, Russian Medical Academy of Continuing Professional Education



E. V. Kleymenova
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences
Russian Federation

Elena B. Kleymenova – MD, PhD, Head of Department of Quality Management of Medical Care, General Medical Center of the Bank of Russia; Deputy Director, Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences; Professor, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education



D. A. Sychev
Russian Medical Academy of Continuing Professional Education
Russian Federation
Dmitry A. Sychev – MD, PhD, Professor, Corresponding Member of Russian Academy of Sciences, Head of Chair of Clinical Pharmacology and Therapy, Vice-Rector for Development and Innovation,


L. P. Yashina
General Medical Center of the Bank of Russia; Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the Russian Academy of Sciences
Russian Federation

Lubov P. Yashina – MD, PhD in Biology, Consultant, Department of Quality Management of Medical Care, General Medical Center of the Bank of Russia; Head of Department, Institute of Modern Information Technologies in Medicine, Federal Research Center “Computer Science and Control” of the RAS



M. D. Nigmatkulova
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Maria D. Nigmatkulova – MD, Post-Graduate Student, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education; Clinical Pharmacologist, General Medical Center of the Bank of Russia



V. A. Otdelenov
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Vitalii A. Otdelenov – MD, PhD, Associate Professor, Chair of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuing Professional Education; Clinical Pharmacologist, General Medical Center of the Bank of Russia



S. A. Payushchik
General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education
Russian Federation

Svetlana A. Payushchik – MD, PhD, Deputy Head of Department of Quality Management of Medical Care, General Medical Center of the Bank of Russia



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For citation:


Chernov A.A., Kleymenova E.V., Sychev D.A., Yashina L.P., Nigmatkulova M.D., Otdelenov V.A., Payushchik S.A. Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing. Rational Pharmacotherapy in Cardiology. 2018;14(4):501-508. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-4-501-508

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)