title: Chest physicians' knowledge of appropriate thromboprophylaxis:  insights from the PROMOTE study.
abstract: Venous thromboembolism (VTE) is a major cause of in-hospital mortality. Several international guidelines provide thromboprophylaxis recommendations; however, guidelines adherence is missing worldwide. We evaluated the chest physicians' knowledge regarding VTE prophylaxis, using a systematically developed questionnaire. The Prophylaxis-foR-venOus-throMbOembolism-assessmenT-questionnairE (PROMOTE) questionnaire was developed using an algorithm encompassing the most important VTE prophylaxis topics and included 13 clinical scenarios. Responses were evaluated with reference to the eighth edition of American College of Chest Physicians guidelines for VTE prevention to assess thromboprophylaxis appropriateness. The questionnaires were distributed during the fourth International Congress on Pulmonary Disease, Intensive Care and Tuberculosis. From the 88 received questionnaires (response rate: 39.8%), 82 were acceptable (62 men, 20 women). The most commonly cited VTE risk factors were immobility (79.2%), surgery (68.2%), and cancer (60.9%). The mean correct response ratio to the questions was 67% [95% confidence interval (CI) 64-70%] with highest appropriateness ratios amongst cardiologists (77.1 ± 5.8%) and lowest ratios among thoracic surgeons (59.2 ± 5%). Physicians' specialty had a significant effect on the overall appropriateness (P = 0.04) and most of appropriateness subcategories. Thoracic surgeons had the lowest rate of over-prophylaxis (P = 0.02). Years passed from graduation were inversely associated with overall appropriateness (P = 0.006). Physicians with academic engagements had a higher overall appropriateness (P = 0.04). We found a wide gap between the guideline recommendations and the responses. PROMOTE is the first systematically developed questionnaire that addresses chest physicians' thromboprophylaxis knowledge and could be useful to strategies to improve VTE prophylaxis. Because of the dissimilar prophylaxis pitfalls of different specialists, distinct educational programs seem necessary to improve their knowledge of proper VTE prophylaxis.
authors: Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran.
authors: Behnood
authors: B
authors: Bikdeli
authors: Babak
authors: B
authors: Sharif-Kashani
authors: Sasan
authors: S
authors: Raeissi
authors: Solmaz
authors: S
authors: Ehteshami-Afshar
authors: Neda
authors: N
authors: Behzadnia
authors: Mohammad-Reza
authors: MR
authors: Masjedi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D007388:Internal Medicine / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013906:Thoracoscopy / Q000009:adverse effects; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants