Agreement of four competing guidelines on prevention of venous thromboembolism and comparison with observed physician practices: a cross-sectional study of 1,032 medical inpatients.
OBJECTIVE
To assess the degree of agreement between four competing guidelines regarding the recommendation for prophylactic heparin therapy and to report to what extent actual practice agreed with or differed from the recommendations made before these guidelines were disseminated.


METHODS
Four French guidelines were applied to data from a cross-sectional study conducted before their dissemination.


METHODS
Twenty-six medical units of a teaching and a nonteaching hospital.


METHODS
One thousand thirty-two medical inpatients.


METHODS
Interguideline agreement rated by the kappa coefficient and percentage of patients receiving prophylactic heparin treatment.


RESULTS
The percentage of patients requiring prophylactic treatment ranged from 35.4% to 54.6% (overall kappa coefficient, 0.65 [0.63 to 0.68]), depending on the guideline. The four guidelines agreed in recommending prophylactic heparin treatment in 330 patients (32.0%). The corresponding rate of prophylactic treatment use was 57.0% (188/330). None of the guidelines recommended prophylactic heparin treatment in 385 patients (37.3%). The physicians did not order prophylactic treatment in 80.3% of these patients (309/385). The guidelines disagreed in recommending prophylactic treatment in 317 patients (30.7%). The corresponding rate of prophylactic treatment use was 32.8% (104/317).


CONCLUSIONS
The four guidelines agreed in 69.3% of patients but physician practices were already quite appropriate in these patients before the guidelines were disseminated. Active dissemination of the guidelines can be expected to improve physician practices in the treatment of these patients, but likely with limited impact. In contrast, the four guidelines disagreed in 30.7% of patients. Further clinical trials are needed in this subgroup of patients.
Labarère
José
J
Unité d'Evaluation Médicale, Centre Hospitalier Universitaire, Grenoble, France. JLabarere@chu-grenoble.fr
Bosson
Jean-Luc
JL
Bergmann
Jean-François
JF
Thilly
Nathalie
N
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005602:France; D019983:Guideline Adherence; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006493:Heparin