At a time of diminishing healthcare resources, clinical guidelines are considered essential tools to reduce inappropriate use of drugs. An audit conducted at our university hospital demonstrated the need to reduce unjustified prescriptions of wet nebulizer (WN) therapy, in order to comply with guidelines and cut costs. The objectives of this study are to establish the major motivating factors for prescription and to evaluate the impact of an intervention aimed at improving doctors’ behaviors.
All the departments of a university hospital were studied before (319 patients) and after (328 patients) a multifaceted intervention which included two educational presentations, posters displayed in all departments, and emails sent to all the doctors and residents.
Numerous factors, apart from the indication, lead to the prescription of WN therapy: Age (OR = 1.025, 95%CI 1.013–1.037, p < 10–3), asthma (OR = 5.48, 95%CI 2.49–12.06), COPD (OR = 28.36, 95%CI 9.46–84.98) and ventilation (OR = 6.54, 95%CI 1.03–41.66) were factors significantly demonstrated by a multivariate analysis using backward logistic regression. Among the 377 patients studied before the intervention, 42(11.7%) were treated by WN despite the lack of indication for treatment and 3(15.8%) needed it but didn’t receive it. These percentages changed to 15.7% and 0% after the intervention, respectively. Patients having acute respiratory diseases requiring nebulizer therapy (and who received it) significantly increased after the intervention (from 80% to 93.3%, p < 10–3). As for chronic patients who did not necessarily need nebulizer therapy, their number increased significantly (from 52.8% to 86.4%, p < 10–3), demonstrating the lack of efficacy of our intervention in that specific field. Overall, the intervention was not found to be statistically related to the change in prescriptions of nebulizer therapy.
Guidelines implemented by multifaceted educational interventions have little effect on clinical practices in a university hospital setting.
More restrictive measures are needed to effectively improve professionals’ behavior in prescribing nebulizer therapy in the hospital setting.
Moussa Riachy, No Financial Disclosure Information; No Product/Research Disclosure Information