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Elyasi S, Fattahi Masum A, Bahreyni A, Samani SS, Atamanesh A, Abdollahi A, Mousavi M. Evaluation of antibiotic prophylaxis for gastrointestinal surgeries in a teaching hospital: An interventional pre-post study. J Perioper Pract 2022; 32:354-360. [PMID: 30888937 DOI: 10.1177/1750458919825583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical site infections are related to a high morbidity, mortality and healthcare costs. Despite ample evidence demonstrating the effectiveness of antimicrobials to prevent surgical site infections, inappropriate timing, antibiotic selection and excessive continuation of antibiotics are common in practice. In this study, we compare the appropriateness of antibiotic prophylaxis in gastrointestinal surgery, before and after an evidence-based guideline implementation. One hundred patients were evaluated in each group. The implementation of the guideline resulted in significant reduction of incorrect use of antibiotics from 55% to 18% (P = 0.002). It also reduced duration of prophylactic antibiotics (43% vs. 23%, P = 0.025). Inappropriate doses diminished but not significantly (8% vs. 5%, P = 0.321). Based on our results, in more than half of of these cases patients received incorrect antibiotic prophylaxis regimens for gastrointestinal surgery in this hospital. Local guideline implementation can result in reduction of antibiotic use, dose and duration errors.
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Affiliation(s)
- Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asiyeh Fattahi Masum
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Bahreyni
- Department of Clinical Biochemistry and Immunogenetic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Ahmad Atamanesh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mousavi
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Mashhad, Iran
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Sallam M, Snygg J. Human albumin solution utilization patterns prior and during COVID-19 pandemic in United Arab Emirates: Time to develop and implement national guidelines on prescription and utilization. NARRA J 2022; 2:e82. [PMID: 38449699 PMCID: PMC10914072 DOI: 10.52225/narra.v2i2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/24/2022] [Indexed: 03/08/2024]
Abstract
The human albumin solution (HAS) has limited but important indications in clinical practices. However, the inappropriate use of HAS can be costly. Thus, it is imperative to establish a practical protocol to use albumin products and rationalize its usage. The aim of this study was to identify HAS utilization patterns in a multi-specialty private hospital in Dubai, United Arab Emirates (UAE), before and during the COVID-19 pandemic. In addition, the objective was to demonstrate the importance of reconsidering the prescribing strategies for HAS administration. All data on 20% HAS administration in Mediclinic Welcare Hospital (MWEL) were retrieved between January 2019 and May 2021, including the total quantities administered and data on primary diagnosis. A total of 579 patient admissions with various diagnoses were included in this study. Our data suggested that the percentage of clinically indicated 20% HAS administrations decreased from 13.0% in the pre-COVID-19 phase to 1.5% in the COVID-19 phase (p<0.001). An increase in the administration of 20% HAS not backed by agreed clinical evidence followed the increase in new number of COVID-19 cases in the UAE. Our study suggests a large proportion of administered HAS, that drastically increased during COVID-19 with lack of evidence of its benefit. This study can be helpful to refine the institutional guidelines of HAS use, and frequent audits and interactive educational interventions are recommended to tackle this issue. In turn, the refinement of HAS administration guidelines could help to reduce the unjustified cost of inappropriate HAS use.
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Affiliation(s)
- Mohammed Sallam
- Department of Pharmacy, Mediclinic Welcare Hospital, Mediclinic Middle East, Dubai, United Arab Emirates
| | - Johan Snygg
- Mediclinic Welcare Hospital, Mediclinic Middle East, Dubai, United Arab Emirates
- The Sahlgrenska Academy at The University of Gothenburg, Gothenburg, Sweden
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Javan-Noughabi J, Parnian E, Hajiesmaeili M, Salehiniya H, Setoodehzadeh F. The impact of a guideline to prevent inappropriate albumin administration in a hospital in Iran. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjhc.2019.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims In Iran, there are no specific national guidelines for the prescription or administration of albumin. Since March 2017, a standard guideline for albumin prescription has been implemented at a hospital in Tehran, Iran. The objective of this study was to compare the use of albumin and its related costs before and after implementation of this guideline. Methods A cross-sectional study was performed at the hospital in 2018. Data regarding albumin prescription were collected using a census method. Collected data included the demographic and clinical information of patients, duration of hospitalisation and the costs of tests and pharmacotherapy consultations before albumin was prescribed. Albumin consumption costs were also collected before and after the implementation of the guideline. Data were analysed using SPSS 21 software and descriptive statistics. Results Albumin consumption was significantly reduced after the guideline was implemented, decreasing from an average of 28 vials (289g) to an average of 6 vials (67g) per patient. The average cost of albumin use also fell from the equivalent of $1218 before the guideline was implemented, to an average of $281 per patient. Conclusions The implementation of a guideline for albumin prescription and administration in a hospital setting resulted in a significant reduction of inappropriate albumin use and the associated costs.
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Affiliation(s)
- Javad Javan-Noughabi
- Clinical Research Development Unit, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Parnian
- Clinical Research Development Unit, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Setoodehzadeh
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Yano Y, Sakata N, Fushimi K. Establishing a hospital transfusion management system promotes appropriate clinical use of human albumin in Japan: a nationwide retrospective study. BMC Health Serv Res 2019; 19:999. [PMID: 31878921 PMCID: PMC6933657 DOI: 10.1186/s12913-019-4836-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/15/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite international recommendations to establish hospital transfusion management systems to promote appropriate use of blood products, the general efficacy of establishing such systems has not been proven. This study aimed to validate the effect of establishing such systems for promoting the appropriate use of human albumin. METHODS In this retrospective observational study, we used a Japanese Diagnosis Procedure Combination (DPC) database from fiscal year 2012 to 2016, which included inpatient records from approximately 1200 hospitals for payment processes in the national medical insurance system. From this existing database, containing approximately 8 million inpatient records per year, we selected patients with emergency due to "bleeding," "sepsis," and "burn injury," by using the International Classification of Diseases and Injuries 10th revision (ICD-10) codes, and hospitals that had one or more patients for each disease group in each fiscal year. We conducted multivariable logistic regression analysis to estimate the relationship between human albumin administration and the state of the hospital transfusion management system. We evaluated temporal trends of mortality rate and length of stay as an indicator of care quality. RESULTS Overall, 139,853 eligible patients admitted to 682 hospitals were selected. The results of the multivariable logistic regression analysis show that patients who were admitted to hospitals with an established hospital transfusion department introducing good practice criteria of blood products were less likely to be administered human albumin compared with those who were admitted to hospitals not introducing it, by approximately 30% for each of the three disease groups; adjusted odds ratios (95% confidential intervals) were 0.70 (0.59-0.83), 0.75 (0.69-0.81), and 0.71 (0.58-0.87) in the "bleeding," "sepsis," and "burn injury" groups, respectively. The temporal trends evaluation shows that there were no increasing trends of mortality rate and average length of stay against decreasing trends of human albumin administration in any disease groups. CONCLUSIONS Establishing a hospital transfusion department responsible for promoting appropriate clinical use of blood products could reduce human albumin administration for critically ill patients without loss of care quality. These findings provide support for policy makers and hospital managers to consider establishing such systems.
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Affiliation(s)
- Yoshiteru Yano
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Nobuo Sakata
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
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Mahmoudi L, Mohammadi R, Niknam R. Economic impact of pharmacist interventions on correction of stress-related mucosal damage prophylaxis practice. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:111-116. [PMID: 30774401 PMCID: PMC6353213 DOI: 10.2147/ceor.s191304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Stress-related mucosal damage (SRMD) is described as the damage of gastric mucosa due to physiological stress that is a very common complication in critically ill patients. SRMD prophylactic medications are widely prescribed all over the world, while numerous studies have revealed that a large percentage of patients admitted to non-intensive care unit (ICU) services do not need to receive these medications. The aim of this study was to determine the frequency and type of medication errors and the economic impact of clinical pharmacist intervention on stress ulcer prophylaxis (SUP). Methods This prospective interventional study was conducted on adult patients admitted to internal, surgical, and critical care units at two large academic medical centers over 6 months. Risk factors of stress ulcer were recorded daily during hospital stay, and appropriateness of SUP administration was assessed according to the American Society of Health-System Pharmacists (ASHP) criteria. An intervention was performed by a clinical pharmacist in the case of contradictions. The rate of inappropriate SUP and the economic impact of a pharmacist intervention were recorded. Results In this study, 178 out of 219 (81.2%) patients received prophylactic treatments. Averagely, prophylactic therapy was compatible with standard treatment guidelines in 67.1% of cases. The implementation of ASHP guideline by a clinical pharmacist resulted in a cost saving of >18,000 USD monthly in this study, which would result in an estimated cost saving of >216,000 USD annually. Conclusion Although treatment guidelines are available for the prophylaxis of SRMD, failure to observe these guidelines could increase the cost of treatment and adverse effects. The clinical pharmacists' intervention in order to implement standard protocols has a significant impact on the reduction of unintended mistakes in prescribing prophylaxis, as well as significant cost savings.
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Affiliation(s)
- Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahim Mohammadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
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Noormandi A, Karimzadeh I, Mirjalili M, Khalili H. Clinical and economic impacts of clinical pharmacists' interventions in Iran: a systematic review. ACTA ACUST UNITED AC 2019; 27:361-378. [PMID: 30674033 DOI: 10.1007/s40199-019-00245-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES There are many studies about Iranian clinical pharmacists' interventions and their impacts on medication safety and cost. The aim of this study is to collect data and critically evaluate the clinical and economic effects of Iranian clinical pharmacist interventions and activities. To our best of knowledge, this research is the first review of publications about Iranian clinical pharmacists' interventions and activities. EVIDENCE ACQUISITION Six online databases, including PubMed, Scopus, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews, and Google Scholar were searched using the terms '"Iranian", "clinical pharmacist", 'adverse drug reactions", "medication errors", "drug interaction", "drug utilization evaluation", "cost", and "interventions" for English studies conducted in Iran and described clinical pharmacist-initiated interventions, published before December 2018. The search and extraction process followed PRISMA guidelines. Observational or retrospective studies, clinical trials, congress abstracts, and case reports or case series were excluded. The search strategy after full-text review identified 39 articles matching the eligibility criteria. RESULTS Thirty-nine articles were recruited. They included establishing pharmaceutical care in out-patient clinics and drug information centers (n = 4); prevention, detection, and management of adverse drug reactions(n = 4), designing protocols and improving drug utilization pattern(n = 16), prevention, detection, and management of medication errors (n = 11), and all clinical pharmacist services(n = 4). Most clinical pharmacist interventions and activities were regarding designing protocols, improving drug utilization pattern, as well as detection, prevention, and management of medication errors. About three-fourth (74.35%) of included studies were from either ambulatory care or in-patient settings in Tehran. The median (interquartile range) duration of intervention as well as follow-up phases was 9 (5) months. CONCLUSION Data of our review support the beneficial role of clinical pharmacists in the improvement of quality, safety, and efficiency of patients' pharmaceutical care in Iran. Graphical abstract Clinical pharmacists' interventions in Iran.
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Affiliation(s)
- Afsaneh Noormandi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O. Box: 14155/6451, Tehran, 1417614411, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, P.O. Box: 14155/6451, Tehran, 1417614411, Iran.
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Altawalbeh SM, Abu-Su'Ud R, Alefan Q, Momany SM, Kane-Gill SL. Evaluating intensive care unit medication charges in a teaching hospital in Jordan. Expert Rev Pharmacoecon Outcomes Res 2019; 19:561-567. [PMID: 30663452 DOI: 10.1080/14737167.2019.1571413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Intensive Care Unit (ICU) medication costs contribute to a large portion of the total ICU costs. Evaluating ICU drug expenditures is essential for optimal resource use especially in countries with limited resources. Considering the dearth of data regarding ICU medication expenses in the Middle East, we sought to evaluate ICU medication charges at a large academic hospital in Jordan. Methods: ICU drug charges were extracted from the hospital administration database at King Abdullah University Hospital for 2014-2015 fiscal years (FYs). ICU drug charges were compared to non-ICU drug charges that were incurred during the same patient admissions. ICU medications with the most significant charges were identified. The most frequent diagnoses with the highest ICU medication charges were described. Results: Average ICU medication charges per day were approximately twice that of non-ICU medication charges ($121.5 versus $55.7 in 2014 and $100.2 versus $52.2 in 2015; p < 0.001 in both FYs). Meropenem and human albumin were the most expensive ICU medications. Drug charge allocation was most expensive for sepsis, motor vehicle accidents and respiratory failure. Conclusion: Drug charges in the ICU are considerably higher than non-ICU drug charges, thus requiring more vigilant cost containment approaches. Further research is needed to evaluate the appropriateness of expensive ICU medications.
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Affiliation(s)
- Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Rawan Abu-Su'Ud
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Qais Alefan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Suleiman Mohammad Momany
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology , Irbid , Jordan
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh , Pittsburgh , PA , USA
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Ebrahimpour S, Nosrati M, Mohammadi M, Kamyab H, Sarayani A, Mahmoodzadeh H, Jahangard-Rafsanjani Z, Gholami K. Impact of Protocol Implementation on Rationalization of Albumin Use in a Tertiary Care Teaching Hospital in Tehran, Iran. J Res Pharm Pract 2019; 7:182-187. [PMID: 30622985 PMCID: PMC6298143 DOI: 10.4103/jrpp.jrpp_18_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients' out-of-pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Methods: This pre-post interventional study was conducted in 32-month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups. Findings: Although hospital bed-days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively (P = 0.001 and P = 0.003). Conclusion: Interactive collaboration through guideline implementation seems effective in rationalizing the use of high-cost medications such as albumin.
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Affiliation(s)
- Sholeh Ebrahimpour
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Nosrati
- Department of Pharmacoeconomics and Pharmaceutical Management, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadi
- Department of Clinical Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
| | - Haniyeh Kamyab
- Department of Pharmaceutical Biotechnology, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sarayani
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Mahmoodzadeh
- Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kheirollah Gholami
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Vazin A, Karimzadeh I, Karamikhah R, Oveisi Z, Mohseni S, Keykhaee M, Roshanfard F, Sabet E, Zargari-Samadnejad A. Clinical and economical impacts of guideline implementation by the pharmaceutical care unit for high cost medications in a referral teaching hospital. BMC Health Serv Res 2018; 18:815. [PMID: 30355286 PMCID: PMC6201544 DOI: 10.1186/s12913-018-3627-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/15/2018] [Indexed: 12/01/2022] Open
Abstract
Background Irrational drug use is a global health challenge in all healthcare settings, such as hospitals. This study evaluated the impact of an intervention by the pharmaceutical care unit on the use pattern of high-value medications and their direct costs in a referral hospital. Methods This interventional, prospective study was carried out in clinical wards of Namazi Hospital (Shiraz University of Medical Sciences) during six months from May 2015 to October 2015. Clinical pharmacists completed the checklists for albumin, intravenous (IV) pantoprazole, and IV immune globulin (IVIG), as three high-cost medications. When ordering these medications, the physicians were asked to complete the checklists. Then, trained pharmacists examined the checklists, based on the clinical and paraclinical conditions. Results The total number of administered medications and their relative cost decreased by 50.76% through guideline implementation; the difference was significant (P < 0.001). In addition, the direct cost of albumin and IV pantoprazole significantly decreased (55.8% and 83.92%, respectively). In contrast, the direct cost of IVIG increased by 40.9%. After guideline implementation, the monthly direct cost of all three medications decreased by $77,720 (55.88%). The all-cause in-hospital mortality rate did not change significantly due to the intervention. The median length of hospital stay was six and seven days, respectively in the pre- and post-intervention periods. Conclusion Based on the findings, implementation of guidelines by the pharmaceutical care unit caused a significant reduction in albumin and IV pantoprazole consumption and reduced their direct costs in a referral center in Iran. Electronic supplementary material The online version of this article (10.1186/s12913-018-3627-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Razieh Karamikhah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Oveisi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Mohseni
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Keykhaee
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Roshanfard
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elaheh Sabet
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asal Zargari-Samadnejad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Dastan F, Jamaati H, Emami H, Haghgoo R, Eskandari R, Hashemifard SS, Khoddami F, Mirshafiei Langari Z. Reducing Inappropriate Utilization of Albumin: The Value of Pharmacist-led Intervention Model. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2018; 17:1125-1129. [PMID: 30127835 PMCID: PMC6094441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Albumin is known as a human blood product, with high cost and limited availability. Several studies have demonstrated the extent in which albumin is being utilized in controversial indications not supported or weakly supported by the available literature. To rationalize the use of albumin and to decrease the inappropriate cost of this expensive drug` a two phase study, with equal length of 66-days, comprising an observational drug utilization evaluation and a pharmacist-led audit and feedback interventional study, was conducted in a tertiary referral hospital in Tehran, Iran. The results of the interventional phase including the introduction of evidence-base guideline for albumin via a pharmacist-led audit and feedback intervention was compared to the ones from the observational phase. A total of 90 and 45 patients were included in the phase one and phase two of the study respectively. During the initial phase, 1870 albumin vials were used, of which 1467 (78.4%) vials were prescribed inappropriately. Inappropriate use of albumin was decreased significantly by 79.3% (p < 0.001) through the interventional phase, leading to 38,800 USD reduction in inappropriate costs of albumin. Introduction of evidence based guideline in conjugation with pharmacist-led audit and feedback can significantly decrease the inappropriate use of albumin. These results also demonstrate shifting towards a more evidence-based practice, which can increase patient's safety and enhance quality of care.
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Affiliation(s)
- Farzaneh Dastan
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Chronic Respiratory Diseases Research Center (CRDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center (CRDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences ,Tehran, Iran.
| | - Rodabeh Haghgoo
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Raha Eskandari
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Fatemeh Khoddami
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Mirshafiei Langari
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Farasatinasab M, Amouzegar A, Safari S, Ghanbari B, Darkahian M, Emami S, Pakdaman N, Salili M. Albumin Utilization Evaluation in a Major Teaching Hospital in Iran: Recommendations for Guideline Development. J Res Pharm Pract 2018; 7:157-163. [PMID: 30211241 PMCID: PMC6121762 DOI: 10.4103/jrpp.jrpp_18_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: Human albumin solution is an expensive colloidal preparation which is commonly used in clinical practice. Due to high cost of albumin, increased rate of the inappropriate use worldwide, and many other reasons, it is imperative to establish a practical protocol to use albumin products and limit its usage. The aim of this study was to identify albumin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for albumin administration. Methods: This retrospective cross-sectional study was performed between August 2016 and December 2016 at Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All albumin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the latest evidence-based studies and guidelines. Findings: Among 320 albumin prescriptions, 168 (52.5%) were inappropriate according to the current evidence. The most common irrational causes for the albumin usage were hypoalbuminemia (23.4%), nutritional support (13.7%), neuroprotection in subarachnoid hemorrhage (3%), pretreatment for cancer surgery (2.8%), edema (1.6%), hepatic failure (1.6%), and paracentesis (3%). The total amount of albumin used for 320 patients was 52,050 g, from which 28,470 g was inappropriate resulting in $97,398 wastage. Conclusion: These findings, along with aforementioned guidelines, support the requirement for physicians' educational programs and proper strategies for appropriate prescriptions and could also be important in modifying the available guidelines concerning expensive drugs such as albumin.
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Affiliation(s)
- Maryam Farasatinasab
- Department of Clinical Pharmacy, Firoozgar Clinical Research Development Center, International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Amouzegar
- Department of Nephrology, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Department of Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ghanbari
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Darkahian
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Emami
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nashmin Pakdaman
- Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Salili
- Department of Pharmacy, Firoozgar Hospital, Hospital Pharmacy Management (Madad Iran Holding), Iran University of Medical Sciences, Tehran, Iran
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Lee EH, Bray V, Horne R. Developing an Economic Case of Clinical Pharmacists' Interventions on Venous Thromboembolism Prophylaxis Through Service Evaluation. J Res Pharm Pract 2017; 6:106-113. [PMID: 28616434 PMCID: PMC5463545 DOI: 10.4103/jrpp.jrpp_16_160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: Venous thromboembolism (VTE) has become a huge health problem as well as a financial burden for the National Health Service. The objective of this study was to characterize current practice of VTE prophylaxis (VTEP) and evaluate the economic impact of clinical pharmacists’ interventions (CPIs) on VTEP. Methods: A prospective service evaluation was conducted in a medical and surgical ward at a tertiary teaching hospital in London from 23 May to 08 June 2016. Appropriateness of risk assessment (RA) and VTEP and CPIs were categorized and assessed. Based on the results of the service evaluation, a pharmacoeconomic analysis was undertaken to estimate the cost savings by CPIs for inappropriate pharmacological VTEP. Findings: A total of 203 cases were analyzed. The rates of appropriateness for RA on admission, RA at 24 h and pharmacological VTEP were 58.6%, 39.7%, and 75.4%, respectively. In the medical ward, there was a significant difference of appropriate RAs between on admission and at 24 h (70.3% vs. 23.8%, respectively). Whereas, the rate of appropriate pharmacological VTEP accounted for 75.4% and the rate of appropriate prophylaxis was significantly higher in the medical ward than surgical ward (80.5% vs. 68.2%, P = 0.045). Of 50 cases of inappropriate pharmacological prophylaxis, 39 cases (78.0%) were corrected by clinical pharmacists. These CPIs resulted in £1,286.23 cost savings during the study and it was estimated to be £517,522/annum. Conclusion: CPIs had significant positive clinical and economic impacts on VTEP. There is more scope for the improvement of RA at 24 h through CPIs.
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Affiliation(s)
- Eun Hee Lee
- Department of Pharmacy, University College London, London, England
| | - Victoria Bray
- Emergency Department, St. George's University Hospitals NHS Foundation Trust, London, England
| | - Robert Horne
- Centre for Behavioural Medicine, University College London, London, England
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Laki B, Taghizadeh-Ghehi M, Assarian M, Heidari K, Torkamandi H, Javadi MR, Gholami K. Effect of hospital-wide interventions to optimize albumin use in a tertiary hospital. J Clin Pharm Ther 2017; 42:704-709. [PMID: 28597926 DOI: 10.1111/jcpt.12566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Albumin has been frequently used as a therapeutic agent based on previous recommendations that are mostly controversial. Considering limited evidence-based indications, common inappropriate albumin use in many hospitals necessitates prompt educational and regulatory interventions. We performed this study to assess the effect of a hospital-wide programme to optimize albumin use in a tertiary referral university-affiliated hospital. METHODS This study was conducted in three 45-day phases, separated by two sequential interventions: guideline implementation and albumin order-sheet consideration. We evaluated albumin use and assessed its appropriateness in each phase at baseline, after guideline implementation and after order-sheet consideration. RESULTS We recorded 100, 93 and 71 albumin orders for 100, 84 and 66 patients during the first, second and third phases, respectively. The adjusted number of albumin orders (used albumin vials) was 94.9 (1481.7 vials), 80.8 (1037.6 vials) and 66 (1219 vials) in the first, second and third phases of the study, respectively. Albumin orders with appropriate indication increased significantly over the three phases of the study (OR=1.5, P=.008). The frequency of inappropriate orders reduced significantly from the first phase to the third phase (58%-27%, P=.007). WHAT IS NEW AND CONCLUSION The pattern and amount of albumin use changed following guideline implementation and order-sheet consideration, and inappropriate albumin use was reduced in our hospital. There was still room for improvement, particularly for indications that were not included in the guideline. Hence, a more comprehensive guideline, frequent audit, feedback and interactive educational approaches might be necessary to achieve results that are of a greater magnitude.
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Affiliation(s)
- B Laki
- Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - M Taghizadeh-Ghehi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - M Assarian
- Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - K Heidari
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - H Torkamandi
- Pharmaceutical Care Department, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M R Javadi
- Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - K Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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14
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Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: an interventional pre-post design study. Int J Clin Pharm 2017; 39:704-711. [PMID: 28540466 DOI: 10.1007/s11096-017-0458-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians' comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5-16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15-149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.
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Flannery AH, Pandya K, Laine ME, Almeter PJ, Flynn JD. Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice. Pharmacotherapy 2016; 37:54-64. [PMID: 27995636 DOI: 10.1002/phar.1862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pharmaceutical costs for patients in the intensive care unit (ICU) constitute a large portion of hospital drug budgets. Unfortunately, prices for medications commonly used in the ICU are on the rise for a variety of reasons. In particular, the U.S. Food and Drug Administration's Unapproved Drugs Initiative, generic manufacturers cornering the marketplace, drug shortages, and regulatory device changes are major drivers of pharmaceutical price escalation affecting costs in the ICU. Furthermore, traditional high acquisition cost items still pose challenges to controlling costs. To offer strategies to mitigate the rising costs of pharmaceuticals in the ICU setting, we searched the PubMed/Medline and International Pharmaceutical Abstracts databases and other related sources to identify published cost-saving protocols concerning specific medications that are affected by rising prices or have traditional high acquisition costs. In the absence of specific protocols, we offer possible cost-saving initiatives based on published literature regarding specific agents or based on our own diverse set of experiences. Finally, we review suggested clinical and operational activities at an institutional level to address these rising drug costs in the ICU setting.
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Affiliation(s)
- Alexander H Flannery
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Komal Pandya
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Melanie E Laine
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky
| | - Philip J Almeter
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky
| | - Jeremy D Flynn
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
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