在临床实践中使用组合疗法和相关事件,试验结果传播后:使用中断时间序列分析的去实施研究
Heather M Campbell1, Allison E Murata2, Adam M Henrie1
1Clinical Research Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, New Mexico; College of Pharmacy, University of New Mexico, Albuquerque, New Mexico.
Clinical therapeutics
|November 12, 2023
概括
传播关于有害组合疗法使用的试验结果迅速减少了VA患者的处方. 这种退出实施策略,比平均水平更快,通过减少急性损伤和高血症,提高了患者的安全性.
科学领域:
- 临床药房 临床药房
- 医疗保健服务研究 医疗服务研究
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 临床实践的变化平均需要17年才能实现试验结果.
- 在2型糖尿病和脏疾病患者中使用有害的组合疗法需要取消实施.
研究的目的:
- 评估传播试验结果对VA系统内组合疗法退出实施的影响.
- 评估这种撤销对处方模式和不良事件的影响.
主要方法:
- 用中断时间序列分析来评估处方模式和干预前后的不良事件.
- 采用了多组件,多层次的退出实施策略,与实施变革的专家建议保持一致.
- 该研究包括VA患者 (2008年7月至2017年11月) 患有2型糖尿病,CKD阶段1-3和白蛋白尿,重点关注那些接受了ACE抑制剂+ARB组合治疗的人.
主要成果:
- 在沟通后的一个月内,组合治疗的使用量每10万名患者减少了331.94.
- 在干预后观察到急性损伤 (36.58%) 和高胆血症 (25.49%) 的显著减少 (P < 0.001).
- 干预前的趋势显示,组合疗法使用的变化很小,不良事件略有增加.
结论:
- 试验结果的传播导致在VA临床实践中快速有效地取消有害组合疗法的实施.
- 美国退伍军人局建立的沟通道和政策促进了退出实施的速度,超过了美国医疗保健的平均水平.
- 该模型展示了有效的策略,以加速基于证据的实践变化在医疗保健组织.
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