TY - JOUR
T1 - The application of official policy
T2 - Prophylaxis recommendations for patients with mitral valve prolapse
AU - Retchin, Sheldon M.
AU - Fletcher, Robert H.
AU - Buescher, Phillip C.
AU - Waugh, Robert A.
AU - Battaglini, Sandra W.
PY - 1985/10
Y1 - 1985/10
N2 - In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy. Overall, only 47 patients (37%) had the antibiotic prophylaxis recommended. Furthermore, information that might have increased the certainty of diagnosis of MVP or the likelihood of mitral insufficiency did not influence the physician’s decision: symptoms, previous history, procedures, sex, evidence for mitral insufficiency, other serious illnesses, or the use of cardiac medications. However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P < 0.05). It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts..
AB - In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis. To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy. Overall, only 47 patients (37%) had the antibiotic prophylaxis recommended. Furthermore, information that might have increased the certainty of diagnosis of MVP or the likelihood of mitral insufficiency did not influence the physician’s decision: symptoms, previous history, procedures, sex, evidence for mitral insufficiency, other serious illnesses, or the use of cardiac medications. However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P < 0.05). It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts..
KW - Endocarditis
KW - Information services
KW - Mitral valve prolapsed
KW - Policymaking
KW - Preventive health services
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U2 - 10.1097/00005650-198510000-00004
DO - 10.1097/00005650-198510000-00004
M3 - Article
C2 - 4058070
AN - SCOPUS:0022213017
SN - 0025-7079
VL - 23
SP - 1156
EP - 1162
JO - Medical care
JF - Medical care
IS - 10
ER -