Multicenter study of the impact of prescription guidelines on the use of colony stimulating factors

The aim of this work was to assess the impact of circulating guidelines for correct prescription practices of colony stimulating factors (CSF). Two ho spital groups were compared, a 'guidelines' group (seven teaching hospitals ) that circulated the guidelines and a control group (eight teaching hospit als) that did not. In addition, two periods were compared before and after distribution of the guidelines: from 17 February to 2 March 1996 and from 1 7 February to 2 March 1997. The assessment involved compliance with the gui delines for the following parameters: indications, dose regimen, time to st art of CSF therapy and duration of CSF therapy between the control and guid eline groups and also between the two periods. The population included 404 patients analyzed (209 in 1996 and 195 in 1997) for the indication of post- chemotherapy neutropenia. Total compliance in the first period (all four it ems) was 44.2% in the control group and 50.8% in the guideline group (non-s ignificant), and during the second period was 31.9 and 59.6% in the two gro ups (p < 0.001). During the first period, the differences in compliance wit h the guidelines for indication, dose regimen, time to start of treatment a nd duration between the groups were not significant. In the second period, this difference became significant and in favor of the guideline group for dose regimen (p=0.009) and treatment duration (p=0.02). The results of this study show the need to continuously define prescription reference systems according to available data, and to circulate them widely to improve the qu ality of health care and to control expenses. [(C) 2000 Lippincott Williams & Wilkins.].