Gestion des anticoagulants : une formation interdisciplinaire pour les résidents en médecine familiale

Implication Statement Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians.Énoncé des implications de la recherche Les anticoagulants sont des médicaments à haut risque qui, mal gérés, peuvent causer des dommages importants aux patients. De nombreux étudiants en médecine et médecins en exercice déclarent que leur formation est inadéquate et qu’ils ont des doutes lorsqu’ils prescrivent un traitement anticoagulant. Pour combler cette lacune, une formation interdisciplinaire en gestion des anticoagulants a été élaborée pour les résidents en médecine familiale au sein de la Toronto Western Family Health Team. Les données d’évaluation de la formation indiquent une amélioration sur le plan des connaissances et de la confiance lors de la prescription, ainsi que sur celui du suivi et de l’ajustement de l’anticoagulothérapie. Ces résultats suggèrent qu’il serait donc pertinent d’envisager l’introduction de formations spécialisées de ce type dans les programmes de médecine familiale pour mieux assurer la sécurité des patients par le développement des connaissances et de l’auto-efficacité des futurs praticiens

Anticoagulation management: an interdisciplinary curriculum for family medicine residents

Implication Statement Anticoagulants are high-risk medications with the potential to cause significant patient harm if inappropriately managed. Medical trainees and practicing physicians often report inadequate education and uncertainty in decision-making related to anticoagulation therapy. To address this gap, an interdisciplinary Anticoagulation Management Training Program was developed for family medicine residents at the Toronto Western Family Health Team. Evaluation data demonstrated both improved knowledge and confidence in prescribing, monitoring, and adjusting anticoagulation therapy. This suggests that similar dedicated curricula be considered in other family medicine programs in order to optimize patient safety by enhancing the knowledge and self-efficacy of future practising physicians

Choosing Wisely: A Retrospective Review of Benzodiazepine/Sedative-Hypnotic Prescribing Practices in Geriatric Patients at an Academic Family Health Team

Pharmacy residents have the opportunity to complete a research project during their residency training, which provides them with skills on how to conduct and manage a research project. Projects often represent an area of interest and need that has been recognized by the host institution’s pharmacy department. Projects are presented as a poster at an annual CSHP Ontario Branch Residency Research Night, and many eventually go on to be published in a peer-reviewed journal.Background: Choosing Wisely Canada aims to reduce unnecessary or potentially harmful tests and treatments. Their list of recommendations for elderly patients, written in collaboration with the Canadian Geriatric Society, states: “Don’t use benzodiazepines or sedative-hypnotics in older adults as first choice for insomnia, agitation, or delirium.” Objective: To determine the concordance between this Choosing Wisely recommendation and the prescribing practices at an academic Family Health Team (FHT). Concordance was defined as the recommendation of non-pharmacologic intervention prior to initiation of a benzodiazepine or sedative-hypnotic (BSH). The secondary objectives were to characterize the prescribing of BSH in elderly patients and assess the rate of adverse events. Methods: A retrospective chart review of active rostered patients at the FHT was undertaken. Patients ≥65 years of age who received a prescription for a benzodiazepine, zopiclone, zolpidem, trazodone, or quetiapine during the period of January 1st 2017 to December 31st 2018 were included. One hundred charts were randomly selected for review. Prescriptions indicated for insomnia, agitation, or delirium were included in the concordance assessment. Results: Of 100 charts, 120 BSH were prescribed during the study period. Of all drugs prescribed for insomnia, agitation, or delirium (n=67), 43% were determined to be concordant with the Choosing Wisely recommendation. The most prescribed BSH for these indications was zopiclone (55%). Benzodiazepines were the most frequently discordant drugs. Thirteen patients had an emergency department visit for a fall or fracture, and 50 patients experienced a fall or near-fall after the first prescription in the study period. Conclusions: Among patients prescribed a BSH for insomnia, agitation, or delirium, less than half were concordant with the Choosing Wisely recommendation, highlighting that there is an opportunity for improvement in the prescribing of BSH in primary care