Analysis of treatment approaches and the efficiency of application of a decision support program in polyclinic practice during the covid-pandemic period

Abstract

Introduction. The issues of rational treatment of a new coronavirus infection (NCI), compliance of medical prescriptions with current clinical recommendations have been extremely relevant since the beginning of the pandemic. Of particular importance is the problem of overprescribing antimicrobials.Aim. To analyze the prescriptions of medicines and evaluate the results of the implementation of the medical decision support system (MDSS) among general practitioners and general practitioners of the Belgorod outpatient department in the treatment of NCIMaterials and methods. Treatment regimens for outpatient patients with confirmed or probable COVID-19 infection were studied. The study was carried out in two stages: before and after the implementation of the MDSS: in the main group (MG, departments of the Belgorod polyclinic with the implemented MDSS), 95 episodes of treatment were analyzed before the implementation of the MDSS and 94 after. In the control group (CG, without the introduction of MDSS) – 48 episodes at the 1st and 2nd stages. The prescriptions of the main groups of drugs, their compliance with the recommendations were assessed, the impact of the introduction of MDSS on the applied therapy regimens was assessed. Statistical analysis was performed using four-field and multi-field contingency tables using Pearson’s χ2 test, Fisher’s exact test.Results. The 285 NCI therapy regimens were analyzed. In the course of the study, the structure of drug prescriptions was determined. It was found that against the background of the implementation of the MDSS, the specialists of the MG statistically significantly reduced the unreasonable prescription of antibacterial drugs (from 24.2 to 6.4%, p < 0.001; in the CG, p > 0.05; p(MG-CG) < 0.001), less frequently prescribed anticoagulants (p(MG-CG) > 0.05); significantly less often – systemic glucocorticosteroids (p(MG-CG) < 0.001), the group of mucolitic, bronchodilator and antitussive drugs (p(MG-CG) < 0.01), vitamins (p(MG-CG) < 0.001); significantly more often (p(MG-CG) < 0.05) – local antiseptics and the group of the other drugs . There were no significant differences (p(MG-CG) > 0.05) at the second stage of the study in the use of antiviral, immunomodulatory, non-steroidal anti-inflammatory drugs.Conclusion. Insufficient adherence of medical specialists to recommendations for the treatment of NCI has been established, a number of irrational therapeutic preferences have been identified. We believe that the follow-up medical educational activities, improvement and rational use of MDSS will help improve the quality of management of patients with NCI.