Giorgio Costantino1, Ludovico Furlan2, Christian Bracco3, Maria Domenica Cappellini4, Giovanni Casazza5, Vanessa Nunziata4, Chiara Beatrice Cogliati5, Anna Fracanzani6, Raffaello Furlan7, Giovanni Gambassi8, Roberto Manetti9, Raffaele Manna10, Alfonso Piccoli11, Alberto Moggi Pignone12, GianMarco Podda13, Teresa Salvatore14, Stefania Sella15, Alessandro Squizzato16, Moreno Tresoldi17, Francesco Perticone18, Antonello Pietrangelo19, Gino Roberto Corazza20, Nicola Montano21. 1. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy. 2. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. 3. Medicina Interna, A.O. Santa Croce e Carle di Cuneo, Italy. 4. Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy. 5. Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy. 6. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Medicina Interna a indirizzo fisiopatologico, ASST Fatebenefratelli Sacco, Milano, Italy. 7. Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy. 8. Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy; Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy. 9. Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy. 10. Institute of Internal Medicine, Periodic Fever and Rare Diseases Research Centre, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy. 11. Medicina Interna, Istituto Clinico San Rocco di Istituti Ospedalieri Bresciani GSD, Italy. 12. Dipartimento Assistenziale Integrato di Emergenza ed Accettazione, Azienda Ospedaliera-Universitaria careggi, Firenze, Italy. 13. Medicina III, San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienza della Salute, Università degli Studi di Milano, Milano, Italy. 14. UOC di Medicina Interna, Azienda Ospedaliera dell'Università degli Studi Luigi Vanvitelli, Napoli, Italy. 15. Dipartimento di Medicina, Clinica Medica 1, Università degli Studi di Padova, Padova, Italy. 16. Università degli Studi dell'Insubria, Varese, Italy. 17. Medicina Generale e delle Cure Avanzate IRCCS Ospedale San Raffaele, Milan, Italy. 18. Università Magna Grecia di Catanzaro, Catanzaro, Italy. 19. Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Italy. 20. Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Italy. 21. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy. Electronic address: nicola.montano@unimi.it.
Abstract
OBJECTIVES: To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. DESIGN: Multicenter, interventional, controlled study. SETTING: Twenty-three acute-care hospital wards in Italy. PARTICIPANTS: 303 Physicians working in internal medicine wards. INTERVENTION: An online educational course. MAIN OUTCOMES: The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. RESULTS: A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081). CONCLUSIONS: A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.
OBJECTIVES: To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. DESIGN: Multicenter, interventional, controlled study. SETTING: Twenty-three acute-care hospital wards in Italy. PARTICIPANTS: 303 Physicians working in internal medicine wards. INTERVENTION: An online educational course. MAIN OUTCOMES: The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. RESULTS: A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081). CONCLUSIONS: A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.