Brief report: Reducing inappropriate usage of stress ulcer prophylaxis among internal medicine residents. A practice-based educational intervention.
BACKGROUND
Many inpatients receive stress ulcer prophylaxis (SUP) inappropriately. This indiscriminate usage increases costs and avoidable side-effects. Practice-based learning and improvement (PBLI) methodology may improve compliance with published guidelines.


OBJECTIVE
To investigate the response of internal medicine residents to an educational intervention regarding SUP.


METHODS
A prospective, pre and postintervention cohort study using an educational intervention based on PBLI.


METHODS
Three groups of consecutively admitted patients (1 group preintervention and 2 groups postintervention) on the medicine ward at a University Hospital.


METHODS
Rates of inappropriate SUP prescription and discharge with an inappropriate prescription.


RESULTS
One month after the intervention, inappropriate prophylaxis was significantly decreased (59% pre, 29% postintervention, P<.002). The rate of discharge with an inappropriate prescription also decreased, but was not significant (25% pre, 14% postintervention, P=.14). In the 6-month postintervention cohort, inappropriate SUP remained lower (59% pre, 33% postintervention, P<.007). The rate of discharge with an inappropriate prescription was also significantly lower (25% pre, 7% postintervention, P<.009).


CONCLUSIONS
Practice-based learning and improvement can improve compliance with published guidelines, and change practice patterns. After the intervention, both inappropriate prophylaxis and inappropriate prescriptions upon discharge were reduced. Importantly, the intervention was sustained, transmitted across academic years to a new class of interns who had not directly experienced the intervention.
Liberman
Joshua D
JD
University of Chicago Hospitals, Chicago, IL, USA. joshdavidlib@yahoo.com
Whelan
Chad T
CT
D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use*; D002641:Chicago; D003365:Costs and Cost Analysis; D006300:Health Services Misuse; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D010437:Peptic Ulcer / Q000191:economics / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018794:Problem-Based Learning / Q000379:methods; D011446:Prospective Studies; D013312:Stress, Physiological
D000897:Anti-Ulcer Agents