Duration of corticosteroid use in chronic obstructive pulmonary disease exacerbations: improving prescribing practices on clinical teaching units with peer-to-peer teaching. Issue 3 (21st July 2018)

• Record Type: Journal Article
• Authors: Matte, Catherine; Hoang, Johnston; Jayaraman, Dev; Green, Laurence; Morin, Suzanne N
• Is Part Of: BMJ open quality. Volume 7:Issue 3(2018)
• Publication Date: 2018-07-21
• Subjects: clinical practice guidelines -- communication -- continuous quality improvement -- medical education -- quality improvement; Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2018-000333
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Introduction: The most recent Global Initiative for Chronic Obstructive Lung Disease consensus recommends a 5-day course of corticosteroid (CS) therapy for acute chronic obstructive pulmonary disease exacerbations (ACOPDE). As inappropriate use of CS therapy is associated with adverse events, we implemented a peer-to-peer education intervention to improve adherence to guidelines for patients with ACOPDE admitted to a medical clinical teaching unit at a tertiary care university centre. Methods: Our study was a before–after design study with a concurrent control of a 15 min peer-to-peer educational intervention targeting medical residents at the beginning of a 4-week rotation for 12 consecutive months. Another medical teaching unit within the same university network, but at a different site, served as a concurrent control. The primary outcome was the proportion of patients who received appropriate duration of CS therapy (5 days) for ACOPDE during the intervention period as compared with the 12-month preintervention period at the intervention and control hospitals. Results: Following the intervention, there was an increase in the proportion of patients receiving appropriate duration of CS therapy (34.2% to 51.3%, p=0.02) at the intervention hospital and no significant difference at the control hospital (22.8% to 34.1%, p=0.15). This effect was maintained at the intervention hospital 3 months postintervention period. Conclusion: A short peer-to-peer educational intervention targeting medical residents on a clinical teaching unit improved adherence to appropriate duration of CS therapy for ACOPDE.