Browsing by Subject "Stewardship"

Now showing 1 - 3 of 3
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    Educational Intervention Improves Proton Pump Inhibitor Stewardship in Outpatient Gastroenterology Clinics
    (Elmer Press, 2019-12) Walker, Megan J.; Crews, Nicholas R.; El-Halabi, Mustapha; Fayad, Nabil F.; Medicine, School of Medicine
    Background Improper chronic proton pump inhibitor (PPI) use has risen significantly in the last few decades. In our gastroenterology trainees’ clinics, we aimed to optimize PPI usage. Methods We collected baseline data on patients’ PPI use for 8 weeks. Based on gastroenterology society guidelines, we determined conditions for appropriate PPI use. If the indication could not be determined, it was categorized as “unknown”. Generated from the three most frequent causes for inappropriate PPI use, interventions were developed to correct each issue. Following a brief educational session, trainees implemented these interventions over a subsequent 8-week interval. Results During our pre-intervention period, trainees evaluated 263 patients who were prescribed a PPI. In 49% of the cases, the use of PPI was deemed inappropriate. The most common reasons were: gastroesophageal reflux disease (GERD) which was never titrated to the lowest effective dose, twice daily dosing for Barrett’s esophagus (BE) chemoprevention and unknown indication. During our intervention period, trainees evaluated 145 patients prescribed a PPI for GERD with well-controlled symptoms in 101 cases. PPI had not been titrated to lowest effective dose in 37 cases prompting intervention which was successful in 23 cases. PPI indication was unknown in 17 cases prompting a message to the prescribing provider to review appropriateness. Two cases of BE chemoprevention with twice daily dosing were appropriately reduced to daily dosing. Ultimately, after intervention, PPI use was deemed appropriate after intervention in 172 (77%) cases. Conclusions Improper chronic PPI use was significant. Focusing intervention efforts on PPI use for GERD, BE and unknown indications substantially increased appropriateness of PPI use.
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    Insights October 2012
    (2012-10) Enright, William
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    Types of Givers: Ideas for Engaging Different Donors
    (Faith+Leader Stewardship, 2023-08-21) Herzog, Patricia Snell
    How do people approach giving to charitable and religious causes? In studying answers to the question, we found that the answer is that there is no one way. Yet, it is not the other extreme either, and the oft-repeated phrase everyone is unique is not helpful. Between these two extremes is a balanced approach in which there are discernable types of givers, and these can inform donor communication. Through a national representative survey and follow-up in-person interviews, we learned from thousands of everyday Americans about the ways they go about their giving.