Adhering to clinical guidelines decreases blood clots in the elderly

A multifaceted intervention designed to increase adherence with clinical guidelines for preventing deep-vein blood clots may decrease the rate of such blood clots among elderly patients, according to a report in the October 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Older adults and those in the hospital are at increased risk for deep vein thrombosis (DVT), a blood clot in the thigh or leg, according to background information in the article. Medications and compression stockings have been shown to reduce or prevent DVT in some patients. "However, several studies demonstrate a gap between scientific evidence and clinical practice in various settings, including post–acute care facilities," the authors write. "These facilities are used to ensure the transition between short hospital stays and home when patients require specialized care or rehabilitation services."

Elodie Sellier, M.D., Joseph Fourier University, Grenoble, France, and colleagues studied 1,373 patients age 65 or older (66.9 percent women) enrolled in 33 post–acute care facilities in France. The researchers evaluated patients for DVT before and after they implemented evidence-based guidelines for physicians and nurses at the facilities regarding prevention of DVT. The guidelines recommended that health care providers give prophylactic (preventive) medications to certain patients, such as those who recently had major surgery or who previously had DVT. Physical therapy, compression stockings and other non-drug preventive measures were recommended for other patients or in addition to medications in some cases. Educational sessions were held to communicate the guidelines; physicians and nurses were given posters and plastic cards as reminders. The researchers assessed 709 patients before and 664 patients following the implementation of the guidelines.

Before the guidelines were put in place, a blood clot was found in 91 (12.8 percent) of 709 patients. Following the intervention, clots were found in only 52 (7.8 percent) of 664 patients. The post-intervention participants were more likely to use compression stockings and less likely to take medications that were not recommended by the guidelines, especially if they were patients for whom drug therapy was not recommended under the guidelines.

"Changes in the prophylaxis means measured can only partly explain the decrease in the rate of DVT observed in our study. The most important change in prophylaxis consisted of an increased use of graduated compression stockings, while the change in pharmacologic prophylaxis use was modest and not statistically significant," the authors write.

"These observations together suggest that our multifaceted intervention not only altered the use of measured prophylaxis means but also improved physician and nurse awareness of patients at risk for venous thromboembolism and eventually increased the use of additional prophylactic measures including early ambulation and physical therapy, which were addressed by our intervention but not investigated in our study," they continue. Additional efforts should be undertaken to ensure that physicians and nurses comply with evidence-based guidelines for the prevention of DVT, they conclude.

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(Arch Intern Med. 2006;166:2065-2071. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the French Ministry of Health and by a grant from the Egide Foundation, Paris. Co-authors Drs. Bosson and Sevestre served as consultants for Sanofi-Aventis France. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.


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