IMPACT OF EDUCATIONAL INTERVENTION ON CONSERVATIVE TREATMENT OF INTESTINAL PSEUDOOBSTRUCTION AND PARALYTIC ILEUS WITH NEOSTIGMINE AT EMERGENCY CENTER OF CLINICAL CENTER KRAGUJEVAC

Abstract

The available data from clinical trials and clinical guidelines clearly suggests that neostig­mine should be administered with a dose of 2-2.5 milligrams in conservative treatment of intestinal pseudo obstruction and paralytic ileus. On the contrary, it has been observed that surgeons at the Clinical Center Kragujevac had a tendency of using neostigmine at a dose of 0.5 milligrams. The aim of this study was to educate surgeons at the Emergency Center of Clinical Center Kragu­jevac by a brochure dealing with the use of neo­stigmine and to assess the economic effects of the conducted education. This health system in­tervention study was conducted on 157 patients who were treated at Emergency Center of Clini­cal Center Kragujevac. The patients diagnosed with intestinal pseudo obstruction or paralytic ileus who received neostigmine were divided into two groups based on the intervention: a group before the intervention and a group after the intervention. The intervention consisted of producing the brochure which contents would give information about the neostigmine use in the treatment of intestinal pseudo obstruction and paralytic ileus. This brochure was then handed out to the surgeons of the Clinical Center Kra­gujevac. In order to evaluate the effects of the conducted intervention the total costs of hospita­lization, drug costs, diagnostic costs, neostigmi­ne-related costs, applied solutions costs as well as the duration of hospitalization in the Emergency Center were compared between the groups. Results show statistically significant dif­ference in the applied dose of neostigmine, in the total costs of hospitalization, in the diagnostics costs, as well as a difference in drug costs between the groups. The duration of hospitaliza­tion was reduced after the conducted interven­tion. This study has shown that the implemented education had an influence on use of neostigmine in conservative treatment of intestinal pseudo ob­struction and paralytic ileus. By transitioning to a new neostigmine dosage regimen of 2-2.5 mili­grams a reduction in the period of hospitalization has been achieved and therefore created a statistically significant reduction of hospitaliza­tion costs.