Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation - 09/09/19
, Stefania Antoniazzi, PhD b, c, Ilaria Ardoino, PhD a, Marco Proietti, MD, PhD a, d, Maura Marcucci, MD e, Paola Santalucia, MD b, f, Valter Monzani, MD g, Pier Mannuccio Mannucci, MD b, Alessandro Nobili, MD athe SIM-AF Collaborators1
Abstract |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Atrial fibrillation, Cluster randomized trial, Internal medicine and geriatric wards, Older people, Oral anticoagulants, SIM-AF trial, Simulation-based education
Esquema
| Funding: The SIM-AF study was funded by a competitive grant from Bristol Myers Squibb/Pfizer Alliance, within the European Thrombosis Investigator-Initiated Research Program (ERISTA) (grant BMS ISR #CV 185-483). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| Conflict of Interest: None. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 132 - N° 8
P. e634-e647 - août 2019 Regresar al número
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