Effect of educational and policy interventions on institutional utilization of wet nebulization respiratory drugs and portable inhalers.
BACKGROUND
Asthma and chronic obstructive pulmonary disease treatment guidelines support the preferential use of portable inhalers (PIs) over wet nebulization (WN) respiratory therapy. Hospital- and community-based educational initiatives and a community-based provincial drug program policy change were previously implemented to promote the conversion of WN therapy to PI and spacer device use in Nova Scotia.


OBJECTIVE
To examine the effect of these interventions on salbutamol, ipratropium bromide, and spacer device (Aerochamber) use at the Queen Elizabeth II Health Sciences Centre (QEII HSC).


METHODS
We conducted a time-series analysis of drug utilization data from August 1998 to July 2005. We used two intervention phases compared to the pre-intervention phase to determine whether the educational and policy interventions were associated with significant changes in monthly drug and spacer device utilization rates at the QEII HSC (1000-bed teaching hospital; Halifax, Nova Scotia).


RESULTS
Salbutamol and ipratropium bromide PI use significantly increased in both intervention phases, compared to the pre-intervention phase. Mean (SD) defined daily doses/100 bed-days for salbutamol PI increased from 30.4 (0.4) in the pre-intervention phase to 34.6 (0.9) and 37.0 (0.4) in intervention phases I and II respectively (p<0.001 for both), and ipratropium bromide PI increased from 27.3 (3.5) to 32.8 (2.5) in intervention phase I (p=0.004) and 35.6 (3.5) in intervention phase II (p<0.001). However, a significant corresponding decrease was observed with salbutamol WN only. Mean (SD) Aerochamber units/100 bed-days significantly increased.


CONCLUSIONS
Educational and policy interventions had limited effects on converting WN to PI use at the QEII HSC.
Lowe
Donna O
DO
Department of Pharmacy Services, University Health Network, Toronto, Ontario. donna.lowe@uhn.on.ca
Lummis
Heather
H
Zhang
Ying
Y
Sketris
Ingrid S
IS
D000280:Administration, Inhalation; D000420:Albuterol / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching; D006801:Humans; D036503:Inhalation Spacers / Q000191:economics / Q000706:statistics & numerical data*; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use; D008173:Lung Diseases, Obstructive / Q000188:drug therapy / Q000191:economics; D009330:Nebulizers and Vaporizers / Q000191:economics / Q000706:statistics & numerical data; D009674:Nova Scotia; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic
D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol