Improving medication titration in heart failure by embedding a structured medication titration plan
| Autor: | John Atherton, Charles Denaro, Alison M. Mudge, Andrew Munns, Louise Marquart, George Javorsky, Annabel Hickey, Jessica Suna |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Medication Therapy Management medicine.drug_class Angiotensin-Converting Enzyme Inhibitors Audit 030204 cardiovascular system & hematology Cohort Studies Angiotensin Receptor Antagonists 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Disease management (health) Beta blocker Aged Retrospective Studies Aged 80 and over Heart Failure Ejection fraction biology business.industry Australia Angiotensin-converting enzyme Middle Aged medicine.disease Patient Discharge Treatment Outcome Heart failure Cohort Emergency medicine ACE inhibitor Physical therapy biology.protein Female Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | International Journal of Cardiology. 224:99-106 |
| ISSN: | 0167-5273 |
| Popis: | To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care.This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments. Evaluation was undertaken using sequential audits, and included process measures (use of the titration plan, assignment of responsibility) and outcome measures (proportion of patients achieving target dose) in HFDM service patients with reduced left ventricular ejection fraction.Comparison of the three patient cohorts (pre-intervention cohort A n=96, intervention cohort B n=95, intervention cohort C n=89) showed increase use of the titration plan, a shift to greater primary care responsibility for titration, and an increase in the proportion of patients achieving target doses of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (A 37% vs B 48% vs C 55%, p=0.051) and beta-blockers (A 38% vs B 33% vs C 51%, p=0.045). Combining all three cohorts, patients not on target doses when discharged from hospital were more likely to achieve target doses of ACEI/ARB (p0.0001) and beta blockers (p0.0001) within six months if they received a medication titration plan.A medication titration plan was successfully implemented in three HFDM services and improved transitional communication and achievement of target doses of evidence-based therapies within six months of hospital discharge. |
| Databáze: | OpenAIRE |
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