Impact of expert recommendations on LMWH venous thromboembolism prophylaxis for non-surgery patients on physician prescriptions

OBJECTIVE: Low-molecular-weight heparins (LMWH) had official approval for u se for venous thromboembolism prophylaxis only for surgery patients when th is survey was conducted, but were nevertheless often used in non-surgery pa tients. We conducted this "before and after" survey from May 1998 to April 1999 to assess the impact of the recommendations implemented in the beginni ng of 1999. METHODS: Data on the use of LMWH were collected on three different days wit hin a three week interval in all non-surgery departments at the Tenon hospi tal before distribution of expert recommendations early in 1999. Published in La Presse Medicale in January 2000, these recommendations issued from an external panel of 43 experts who were contacted to establish a consensus o pinion using the Delphi method. Data were again collected on three differen t days after implementation of the recommendations, implementation was base d on a patient-specific prescription order form requested by the hospital p harmacy for delivery to the department. RESULTS: Data were collected for 121 prescriptions prior to the recommendat ions and for 158 after. Sex-ratio, mean age and percentage of LMWH prescrip tions did not differ significantly between the two periods. There was a low er number of non-appropriate prescriptions after implementation of the reco mmendations from 54.5% to 35.4% (p = 0.01) with better conformity for recom mendation A (high-risk patients) (36% venus 43%, NS) and for recommendation B (= 2 risk situations or = 1 risk situation and = 2 aggravating factors) (10% versus 22%, p=0.01). Better conformity of LMWH prescriptions in oncolo gy and radiotherapy departments partially explained this general improvemen t, but the difference remained significant when excluding these two departm ents (p = 0.04). CONCLUSION: This study shows that physician compliance with recognized expe rt recommendations can improve their implementation. This procedure is now in general use in the Tenon hospital.