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Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative
Author(s) -
Wai A.,
Pulver L. K.,
Oliver K.,
Thompson A.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2010.02308.x
Subject(s) - medicine , acute coronary syndrome , referral , medical prescription , emergency medicine , psychological intervention , audit , guideline , chest pain , rehabilitation , physical therapy , emergency department , telephone interview , myocardial infarction , family medicine , nursing , social science , management , pathology , sociology , economics
Background: Evidence–practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. Aim: We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline‐recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. Methods: DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4‐month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Results: Forty‐nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta‐blocker, statin and angiotensin‐converting enzyme inhibitor and/or angiotensin II‐antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as ‘very good’ to ‘excellent’. Conclusions: The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of patients with ACS.