Abstract 15: Telephone Intervention to Improve Quality and Safety After Percutaneous Coronary Intervention
Notice bibliographique
Résumé
Context: Poor adherence to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is associated with poor outcomes including stent thrombosis, rehospitalization, and mortality. Safety-net patients are at high risk for low adherence due to poor health literacy and financial constraints. Understanding and overcoming barriers to patient adherence to DAPT after PCI may reduce the risk of adverse outcomes in safety-net patients. Objective: A multidisciplinary team of Nurses, Pharmacists, Internal Medicine Residents, and Cardiologists designed and implemented a telephone-based intervention to improve adherence to DAPT after PCI at Parkland Health & Hospital System (PHHS), a safety-net hospital system in Dallas, Texas. Methods: Beginning 9/1/17, nurses from the Parkland Cardiac Catheterization Laboratory called all PCI patients 7, 30, and 90 days post-PCI. Patients were reminded of the importance of DAPT and asked if they had concerns about their medications. Specific issues that arose were handled by the multidisciplinary team via interventions such as: provision of vouchers for reduced-cost medications, change in pharmacy or medication to lower cost, appointment with Pharmacy or Cardiology clinicians to discuss medication, confirmation of active refills. The total number of patients with self-reported nonadherence was quantified, as was proportion of days covered (PDC) on DAPT at 6 months, defined as the total number of days filled in the first 6 months post-PCI divided by 180 days. Results: From 9/1/17 - 2/28/18, 189 patients underwent PCI at Parkland. Of these patients, 67% (127 of 189) were able to be contacted, with 10% (13 of 127) of contacted patients reporting problems with medications resulting in complete nonadherence and requiring intervention. Of the total treated patients, 65% (123 of 189) had prescriptions filled at PHHS pharmacies which allowed for manual calculation of adherence data and 72% (89 of 123) of these patients were successfully contacted. Median PDC was 94% at 6 months, with PDC >90% in 59% (72 of 123) of all patients and 62% (55 of 89) of successfully contacted patients. A historical control sample (N=154) who underwent PCI at Parkland from 1/1/16 - 8/31/17 and filled prescriptions at PHHS pharmacies had a median PDC of 92% at 6 months, with PDC >90% in 55% (84 of 154). There was no significant difference in median PDC (p=0.4) or proportion of patients with PDC >90% in either all-study (p=0.37) or successful contact (p=0.19) patient populations compared to this control. Conclusion: A telephone-based intervention allowed for identification and resolution of potentially catastrophic barriers to DAPT adherence in 1 in 10 contacted patients within 6 months post-PCI. However, it was unable to significantly improve medication adherence as measured by PDC, indicating that this adherence metric may not be an adequate measure of impact in this context.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».