Effectiveness of a multifaceted intervention on reducing non-guideline-concordant prescribing of calcium and vitamin D analogues after total thyroidectomy.
Multifaceted intervention associated with lower non-guideline calcium/vitamin D prescribing after thyroidectomy
Effectiveness of a multifaceted intervention on reducing non-guideline-concordant prescribing of calcium and vitamin D analogues after total thyroidectomy.
Postoperative hypocalcemia is a common complication of total thyroidectomy.
To determine if a multi-faceted intervention could reduce NGC-CaVD after total thyroidectomy, assess safety outcomes, and identify factors associated with inappropriate prescribing.
This retrospective observational cohort study included 629 adults undergoing total thyroidectomy (322 pre-intervention, 307 post-intervention).
non-guideline calcium/vitamin D prescribing dropped after the intervention
Results Improvements were also seen in specific areas: inappropriate calcium preparation selection (8.07% versus 2.93%, p < 0.01), calcium dosage (23.91% versus 11.73%, p < 0.01), vitamin D analogue dosage (30.75% versus 6.84%, p < 0.01), and delayed IV to oral switch (4.97%-1.95%, p = 0.04).
The per-group NGC-CaVD cost decreased from RMB 17.34 (IQR: 0, 19.56) to RMB 4.42 (IQR: 0, 0) (p < 0.01).
The main barrier influencing NGC-CaVD was physician-related factors, including excessive concern for the risk of postoperative hypocalcemia.
The implementation of a multi-faceted intervention improved guideline adherence for postoperative prescribing of calcium and vitamin D analogues without affecting symptomatic hypocalcemia and length of stay.
Additionally, the model provides a framework for the standardization of post-thyroidectomy hypocalcemia management and the improved appropriateness of medication prescribing.