Uptake of new treatment strategies for deep vein thrombosis: an international audit.
OBJECTIVE
Study of the uptake of new medical technologies provides useful information on the transfer of published evidence into usual practice. We conducted an audit of selected hospitals in three countries (Canada, France, and Switzerland) to identify clinical predictors of low-molecular-weight (LMW) heparin use and outpatient treatment, and to compare the pace of uptake of these new therapeutic approaches across hospitals.


METHODS
Historical review of medical records.


METHODS
We reviewed the medical records of 3043 patients diagnosed with deep vein thrombosis (DVT) in five Canadian, two French, and two Swiss teaching hospitals from 1994 to 1998. Measures. We explored independent clinical variables associated with LMW heparin use and outpatient treatment, and determined crude and adjusted rates of LMW heparin use and outpatient treatment across hospitals.


RESULTS
For the years studied, the overall rates of LMW heparin use and outpatient treatment in the study sample were 34.1 and 15.8%, respectively, with higher rates of use in later years. Many comorbidities were negatively associated with outpatient treatment, and risk-adjusted rates of use of these new approaches varied significantly across hospitals.


CONCLUSIONS
There has been a relatively rapid uptake of LMW heparins and outpatient treatment for DVT in their early years of availability, but the pace of uptake has varied considerably across hospitals and countries.
Aujesky
Drahomir A
DA
University of Lausanne.
Cornuz
Jacques
J
Bosson
Jean-Luc
JL
Bounameaux
Henri
H
Emmerich
Joseph
J
Hull
Russell D
RD
Mackay
Elizabeth
E
Perrier
Arnaud
A
Quan
Hude
H
Tsuyuki
Ross T
RT
Ghali
William A
WA
D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use*; D002170:Canada; D005260:Female; D005602:France; D006302:Health Services Research; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D005791:Patient Care; D013557:Switzerland; D020246:Venous Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight