Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation

the SIM-AF Collaborators, Carlotta Franchi, Stefania Antoniazzi, Ilaria Ardoino, Marco Proietti, Maura Marcucci, Paola Santalucia, Valter Monzani, Pier Mannuccio Mannucci, Alessandro Nobili

Research output: Contribution to journalArticle

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Abstract

Purpose: This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods: We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results: Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions: This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration: ClinicalTrials.gov identifier: NCT03188211.

Original languageEnglish
Pages (from-to)e634-e647
JournalAmerican Journal of Medicine
Volume132
Issue number8
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Anticoagulants
Atrial Fibrillation
Physicians
Education
Confidence Intervals
Internal Medicine
Geriatrics
Prescriptions
Odds Ratio
Learning

Keywords

  • Atrial fibrillation
  • Cluster randomized trial
  • Internal medicine and geriatric wards
  • Older people
  • Oral anticoagulants
  • SIM-AF trial
  • Simulation-based education

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation. / the SIM-AF Collaborators; Franchi, Carlotta; Antoniazzi, Stefania; Ardoino, Ilaria; Proietti, Marco; Marcucci, Maura; Santalucia, Paola; Monzani, Valter; Mannucci, Pier Mannuccio; Nobili, Alessandro.

In: American Journal of Medicine, Vol. 132, No. 8, 01.01.2019, p. e634-e647.

Research output: Contribution to journalArticle

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abstract = "Purpose: This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods: We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results: Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3{\%}) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95{\%} confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1{\%}; 95{\%} CI, 0{\%}-31.5{\%}) and with direct oral anticoagulants (DOACs) (20{\%}; 95{\%} CI, 0{\%}-39.8{\%}) increased more in the intervention than in the control arm. Conclusions: This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration: ClinicalTrials.gov identifier: NCT03188211.",
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AU - Antoniazzi, Stefania

AU - Ardoino, Ilaria

AU - Proietti, Marco

AU - Marcucci, Maura

AU - Santalucia, Paola

AU - Monzani, Valter

AU - Mannucci, Pier Mannuccio

AU - Nobili, Alessandro

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N2 - Purpose: This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods: We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results: Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions: This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration: ClinicalTrials.gov identifier: NCT03188211.

AB - Purpose: This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods: We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results: Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions: This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration: ClinicalTrials.gov identifier: NCT03188211.

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KW - Oral anticoagulants

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