Use of Evidence-Based Therapy at Discharge: METHODS
This retrospective study involved patients discharged from 2 adult acute care sites of Eastern Health. At the time of the study, the 2 sites had a total of about 550 acute care beds, and each contained a coronary care unit. One of these sites housed the cardiac catheterization laboratory and the cardiac surgery program for the entire province. During the 2007/2008 fiscal year, a total of 526 coronary artery bypass graft procedures and 766 percutaneous coronary interventions were performed. Eastern Health is also affiliated with the province’s only university (Memorial University of Newfoundland), having particularly strong links to its medical and allied health professional schools.
Patients were identified from Eastern Health’s administrative database on the basis of the International Classification of Diseases, 9th Revision (ICD-9) code for acute myocardial infarction. Patients were eligible for inclusion in the review if they had been discharged with a primary (most responsible) diagnosis of acute myocardial infarction between April 1, 2004, and March 31, 2005.
One research nurse collected data from the patients’ medical records using a standardized data collection form. These data included descriptive information (i.e., demographic characteristics, type of myocardial infarction, relevant comorbidities, and medications on admission and discharge) and additional evidence of contraindications or criteria that would exclude a patient from therapy (e.g., serum creatinine concentration, left ventricular function). The data collected were limited to details documented in the medical record. For each patient, the medication classes of interest were deemed to have been prescribed on discharge if a discharge prescription had been written or if the drug was listed in the patient’s discharge summary. canada drugs online
The CCORT/CCS document6 listed exclusions for each of the classes of medications (Table 1). For patients for whom the medications of interest had not been prescribed on discharge, information was sought to determine if at least one of the exclusion criteria applied.
Data analysis was performed using SPSS statistical software for Windows (version 15.0; SPSS Inc, Chicago, Illinois). Frequencies, means, and standard deviations (SDs) were used to describe the patients’ characteristics. Rates of discharge prescribing for the 4 classes of medications were calculated for all patients, as well as for the subset of “ideal” patients for each drug class (i.e., those without documented contraindications or reasons for nonprescribing). The rates for “ideal” patients were compared with the CCORT/CCS benchmarks. This project was approved by the Human Investigations Committee, Memorial University of Newfoundland.