Impact de recommandations sur la qualité de la prise en charge médicamenteuse de l'insuffisance cardiaque : étude de l'intervention contrôlée randomisée en milieu hospitalier

Abstract : Heart failure remains a serious problem of public health in industrialised countries. Many clinical trials have demonstrated the efficacy of Angiotensin Converting Enzyme (ACE) inhibitors to reduce morbidity and mortality in systolic heart failure. Nervertheless, international literature and the results of the EPICAL program have reported their underutilisation in medical practice. In this context, a cluster randornised controlled trial was initiated in twenty cardiology units involved in EPICAL. The aim was to evaluate the effect of developing and implementing guidelines on the quality of care given to patients receiving ACE inhibitors for systolic heart failure. The matched units were randomly assigned to two groups : an experimental group where physicians were involved in drafting and implementing guidelines and a control group where no intervention was performed. Two surveys were conducted in both groups of units, the first before intervention and the second after ; 723 patients with systolic heart failure and less than 75 years old were included. Before intervention, clinicians in both groups were non compliant with guidelines relating to ACE inhibitors doses and therapeutic information in medical file. After intervention, compliance with these guidelines was better, while non significantly, in the experimental group, with a higher increase beetween the two periods in this group. These results suggest that the development and the implementation of guidelines, involving physicians, may improve the quality of therapeutic care given to their patients.
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Nathalie Thilly. Impact de recommandations sur la qualité de la prise en charge médicamenteuse de l'insuffisance cardiaque : étude de l'intervention contrôlée randomisée en milieu hospitalier. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2003. Français. ⟨NNT : 2003NAN11306⟩. ⟨tel-01777287⟩

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