Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation
| Autor: | Franchi, C, Antoniazzi, S, Ardoino, I, Proietti, M, Marcucci, M, Santalucia, P, Monzani, V, Mannucci, Pm, Nobili, A, Bosari, S, Brignoto, B, Nicolis, E, Fenoglio, Lm, Melchio, R, Fabris, F, Sartori, Mt, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabba, C, Suppressa, P, Bandiera, F, Usai, CINZIA PATRIZIA, Murialdo, G, Fezza, Fabrizio, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, Gherardo, Ceriani, G, Lucchi, T, Brignolo, B, Manfellotto, D, Caridi, I, Corazza, Gr, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, Nl, Tognin, T, Rozzini, R, Bellucci, Fb, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Raviolo, P, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Ruatta, C, Dallegri, F, Ottonello, Lc, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, Aa, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, Mazzeo, M |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Cluster randomized trial Socio-culturale Administration Oral 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine and geriatric wards Intervention (counseling) Hospital discharge medicine Odds Ratio Cluster Analysis Humans 030212 general & internal medicine Cluster randomised controlled trial Medical prescription Simulation based Simulation Training Simulation-based education LS4_7 Aged Aged 80 and over business.industry Anticoagulants Atrial fibrillation General Medicine Odds ratio medicine.disease Older people Oral anticoagulants SIM-AF trial Confidence interval Atrial fibrillation Cluster randomized trial Internal medicine and geriatric wards Older people Oral anticoagulants SIM-AF trial Simulation-based education Patient Simulation Stroke Geriatrics Emergency medicine Education Medical Continuing Female Clinical Competence business |
| Popis: | Purpose This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration ClinicalTrials.gov identifier: NCT03188211. |
| Databáze: | OpenAIRE |
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