Uptake of a guideline for the administration of a rescue course of antenatal corticosteroids

Ilina Datkhaeva, Danielle Dray, Phinnara Has, Bianca Stifani, Brenna L. Hughes, Dwight J. Rouse

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.

Original languageEnglish (US)
Pages (from-to)720-726
Number of pages7
JournalObstetrics and gynecology
Volume129
Issue number4
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Adrenal Cortex Hormones
Guidelines
Confidence Intervals
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Uptake of a guideline for the administration of a rescue course of antenatal corticosteroids. / Datkhaeva, Ilina; Dray, Danielle; Has, Phinnara; Stifani, Bianca; Hughes, Brenna L.; Rouse, Dwight J.

In: Obstetrics and gynecology, Vol. 129, No. 4, 01.01.2017, p. 720-726.

Research output: Contribution to journalArticle

Datkhaeva, Ilina ; Dray, Danielle ; Has, Phinnara ; Stifani, Bianca ; Hughes, Brenna L. ; Rouse, Dwight J. / Uptake of a guideline for the administration of a rescue course of antenatal corticosteroids. In: Obstetrics and gynecology. 2017 ; Vol. 129, No. 4. pp. 720-726.
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abstract = "OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6{\%}) were eligible for a rescue course, of whom 103 (73{\%}) received it. The rate of appropriate administration increased from 18.2{\%} (95{\%} confidence interval [CI] 5-40{\%}) in 2008 to 65.4{\%} (95{\%} CI 44-83{\%}) in 2009, 93.5{\%} (95{\%} CI 79-99{\%}) in 2010, 96.1{\%} (95{\%} CI 80-99{\%}) in 2011, and 75.7{\%} (95{\%} CI 59-88{\%}) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3{\%}) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4{\%} (95{\%} CI 0.04-1.4{\%}) in 2008 to 1.9{\%} (95{\%} CI 0.9-3.5{\%}) in 2009, 1.8{\%} (95{\%} CI 0.8-3.6{\%}) in 2010, 2.4{\%} (95{\%} CI 1.2-4.3{\%}) in 2011, and 2.2{\%} (95{\%} CI 1.1-4.0{\%}) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28{\%} (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.",
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AU - Datkhaeva, Ilina

AU - Dray, Danielle

AU - Has, Phinnara

AU - Stifani, Bianca

AU - Hughes, Brenna L.

AU - Rouse, Dwight J.

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N2 - OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.

AB - OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.

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