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Schönenberger N, Meyer-Massetti C. Risk factors for medication-related short-term readmissions in adults - a scoping review. BMC Health Serv Res 2023; 23:1037. [PMID: 37770912 PMCID: PMC10536731 DOI: 10.1186/s12913-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. METHODS We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. RESULTS After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems-especially underprescribing and suboptimal drug selection-and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. CONCLUSIONS This study's findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.
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Affiliation(s)
- N Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
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2
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Riester MR, Zullo AR. Prediction tool Development and Implementation in pharmacy praCTice (PreDICT) proposed guidance. Am J Health Syst Pharm 2023; 80:111-123. [PMID: 36242567 DOI: 10.1093/ajhp/zxac298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Proposed guidance is presented for Prediction tool Development and Implementation in pharmacy praCTice (PreDICT). This guidance aims to assist pharmacists and their collaborators with planning, developing, and implementing custom risk prediction tools for use by pharmacists in their own health systems or practice settings. We aimed to describe general considerations that would be relevant to most prediction tools designed for use in health systems or other pharmacy practice settings. SUMMARY The PreDICT proposed guidance is organized into 3 sequential phases: (1) planning, (2) development and validation, and (3) testing and refining prediction tools for real-world use. Each phase is accompanied by a checklist of considerations designed to be used by pharmacists or their trainees (eg, residents) during the planning or conduct of a prediction tool project. Commentary and a worked example are also provided to highlight some of the most relevant and impactful considerations for each phase. CONCLUSION The proposed guidance for PreDICT is a pharmacist-focused set of checklists for planning, developing, and implementing prediction tools in pharmacy practice. The list of considerations and accompanying commentary can be used as a reference by pharmacists or their trainees before or during the completion of a prediction tool project.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Departments of Health Services, Policy, and Practice and Epidemiology, Brown University School of Public Health, Providence, RI.,Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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Wembridge P, Ngo C, Tran THT, Ivar MP. Evaluating pharmacy
high‐needs
criteria: a tool for identifying inpatients at risk of medication‐related problems. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Cathy Ngo
- Eastern Health Box Hill Victoria Australia
- Monash University Melbourne Victoria Australia
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4
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Rudawsky N, Patel HU. Impact of a Transition of Care Pharmacist in a Community Hospital Discharge Model. J Healthc Qual 2022; 44:347-353. [PMID: 36318295 DOI: 10.1097/jhq.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pharmacists can provide a variety of discharge services that aid in transitions of care. The purpose of this study is to evaluate the impact of a pilot program implementing a unit-based clinical pharmacist at a community teaching hospital. METHODS This prospective study evaluated pharmacist-led discharge services on an adult medicine unit over a 5-week period. The control cohort received usual care, and the intervention cohort received additional pharmacy services (e.g., counseling, medication reconciliation, ensuring medication access, and overcoming discharge barriers). The primary outcome was 30-day all-cause hospital readmissions. Secondary outcomes included emergency department (ED) utilization, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and patient satisfaction survey scores. RESULTS Overall, 197 patients were included in the control group and 210 in the intervention group. Characteristics including previous hospital utilization, comorbidity count, and medication count at discharge were similar between groups. A reduction in 30-day all-cause hospital readmissions was observed in the cohort receiving pharmacist intervention, 13.3% versus 20.8% (p = 0.044). This study also demonstrated a significant decrease in ED utilization rates and improved patient satisfaction. CONCLUSIONS This study adds to the growing body of literature supporting transition of care pharmacists in the hospital discharge model to improve patient care.
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Fung L, Huynh T, Brush T, Medders K, El‐Kareh R, Daniels CE. A Correlation of a Medication‐Focused Risk Score to Medication Errors at Discharge. J Clin Pharmacol 2020; 60:1416-1423. [DOI: 10.1002/jcph.1642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Linli Fung
- Department of Pharmacy UC San Diego Health San Diego California USA
| | - Trina Huynh
- Department of Pharmacy UC San Diego Health San Diego California USA
| | - Theresa Brush
- Department of Pharmacy UC San Diego Health San Diego California USA
| | - Kathryn Medders
- Department of Pharmacy UC San Diego Health San Diego California USA
| | - Robert El‐Kareh
- Department of Medicine UC San Diego Health San Diego California USA
| | - Charles E. Daniels
- Department of Pharmacy UC San Diego Health San Diego California USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences UC San Diego San Diego California USA
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6
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McConachie SM, Raub JN, Yost R, Monday L, Agrawal S, Tannous P. Evaluation of a multidisciplinary approach to reduce internal medicine readmissions using a readmission prediction index. Am J Health Syst Pharm 2020; 77:950-957. [DOI: 10.1093/ajhp/zxaa078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Readmission prediction indices are used to stratify patients by the risk of hospital readmission. We describe the integration of a 30-day hospital readmission prediction index into the electronic medical record (EMR) and its impact on pharmacist interventions during transitions of care (TOC).
Methods
A retrospective cohort study was conducted to compare 30-day readmission rates between adult internal medicine inpatients admitted by a multidisciplinary team providing TOC services (the TOC group) and those who received usual care (the control group). Interventions by a pharmacist serving on the TOC team were guided by an EMR-integrated readmission index, with patients at the highest risk for readmission receiving targeted pharmacist interventions. Inpatient encounters (n = 374) during the 5-month study period were retrospectively identified. Chi-square and Mann-Whitney U tests were performed to analyze differences in nominal and nonparametric continuous variables, respectively. Logistic regression was performed to identify variables associated with 30-day readmissions. The log-rank test was used to analyze hazard ratios for readmission outcomes in the 2 cohorts.
Results
Thirty-day readmission rates did not differ significantly in the TOC group and the control group (20.9% vs 18.3%, P = 0.52). However, patients who received additional direct pharmacist interventions, as guided by use of a hospital readmission index, had a lower 30-day readmission rate than patients who did not (11.4% vs 21.7%, P = 0.04). The readmission index score was significantly associated with the likelihood of 30-day readmission (odds ratio for readmission, 1.25; 95% confidence interval, 1.16-1.34; P < 0.01). The difference in unadjusted log-rank scores at 30 days with and without pharmacist intervention was not significant (P = 0.05). A mean of 4.5 medication changes were identified per medication reconciliation performed by the TOC pharmacist.
Conclusion
A multidisciplinary TOC team approach did not reduce the 30-day readmission rate on an internal medicine service. However, patients who received additional direct pharmacist interventions guided by a readmission prediction index had a reduced readmission rate.
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Affiliation(s)
- Sean M McConachie
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, and Beaumont Hospital, Dearborn, Dearborn, MI
| | - Joshua N Raub
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Raymond Yost
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Lea Monday
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, and Wayne State University School of Medicine, Detroit, MI
| | - Shivani Agrawal
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, and Wayne State University School of Medicine, Detroit, MI
| | - Pierre Tannous
- Department of Internal Medicine, Detroit Medical Center, Detroit, MI, and Wayne State University School of Medicine, Detroit, MI
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7
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Vest TA, Gazda NP, Schenkat DH, Eckel SF. Practice-enhancing publications about the medication-use process in 2018. Am J Health Syst Pharm 2020; 77:759-770. [PMID: 32378716 DOI: 10.1093/ajhp/zxaa057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change. SUMMARY A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level.
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Affiliation(s)
- Tyler A Vest
- Duke University Hospital, Durham, NC, and University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, and University of North Carolina Medical Center, Chapel Hill, NC
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Brady A, Curtis CE, Jalal Z. Screening Tools Used by Clinical Pharmacists to Identify Elderly Patients at Risk of Drug-Related Problems on Hospital Admission: A Systematic Review. PHARMACY 2020; 8:E64. [PMID: 32290347 PMCID: PMC7355869 DOI: 10.3390/pharmacy8020064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 01/15/2023] Open
Abstract
None of the models met the four key stages required to create a quality risk prediction model. Further research is needed to either refine the tools developed to date or develop new ones that have good performance and have been externally validated before considering the potential impact and implementation of such tools.
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Affiliation(s)
- Amanda Brady
- Pharmacy Department, Sligo University Hospital, Sligo F91 H684, Ireland;
| | - Chris E. Curtis
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;
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Patel GP, Hyland SJ, Birrer KL, Wolfe RC, Lovely JK, Smith AN, Dixon RL, Johnson EG, Gaviola ML, Giancarelli A, Vincent WR, Richardson C, Parrish RH. Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gourang P. Patel
- Department of Pharmacy, Division of Pulmonary and Critical Care Medicine; Department of Anesthesiology, Rush Medical College, Rush University Medical Center Chicago; Illinois
| | - Sara J. Hyland
- Pharmacy Services; Grant Medical Center-OhioHealth; Columbus Ohio
| | - Kara L. Birrer
- Pharmacy Services; Orlando Regional Medical Center/Orlando Health; Orlando Florida
| | - Rachel C. Wolfe
- Department of Pharmacy; Barnes-Jewish Hospital; St. Louis Missouri
| | | | - April N. Smith
- Department of Pharmacy Practice; Creighton University; Omaha Nebraska
- Department of Pharmacy; CHI Immanuel Medical Center; Omaha Nebraska
| | - Russell L. Dixon
- Department of Trauma; Surgical, and Neurological Critical Care, St John Medical Center; Tulsa Oklahoma
| | - Eric G. Johnson
- Department of Pharmacy Services; University of Kentucky HealthCare; Lexington Kentucky
- Department of Pharmacy Practice and Science; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - Marian L. Gaviola
- Department of Pharmacotherapy; University of North Texas System College of Pharmacy; Fort Worth Texas
| | - Amanda Giancarelli
- Pharmacy Services; Orlando Regional Medical Center/Orlando Health; Orlando Florida
| | | | - Carole Richardson
- Pharmacy Information Services; Emory Healthcare, Inc; Atlanta Georgia
| | - Richard H. Parrish
- Department of Pharmacy; St. Christopher's Hospital for Children; Philadelphia Pennsylvania
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10
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Wood M, Sweeney T, Trayah M, Civalier M, McMillian W. The Impact of Transitions of Care Pharmacist Services and Identification of Risk Predictors in Heart Failure Readmission. J Pharm Pract 2019; 34:567-572. [PMID: 31665955 DOI: 10.1177/0897190019884173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure (HF) is a prevalent and costly disease state for adult Americans, with 30-day readmissions rates for patients with HF utilized to limit hospital compensation. OBJECTIVE To determine the impact of the transitions of care (TOC) service at our institution on 30-day all-cause and HF readmissions and identify predictive risk factors for 30-day all-cause readmission. METHODS Retrospective chart review of patients aged 18 years and older admitted with HF and all subsequent readmissions between October 1, 2015, and September 30, 2017. A weighted logistic regression model was developed to determine risk factors for 30-day all-cause readmission. RESULTS There were no significant differences in all-cause or HF readmission rates analyzed by TOC service involvement. Significant risk predictors for 30-day all-cause readmission included discharge to a rehabilitation facility (odds ratio [OR] = 9.3) or home with home health (OR = 1.6) versus home with self-care. Comorbidities associated with an increased risk of 30-day all-cause readmission included diabetes, coronary artery disease, and aortic stenosis. Use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and spironolactone was associated with decreased risk of 30-day all-cause readmission. CONCLUSION Identified predictors in the patient population with HF at our institution may be used to target patients at increased risk of all-cause readmission within 30 days.
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Affiliation(s)
- Marci Wood
- Department of Pharmacy, 2090University of Vermont Medical Center, Burlington, VT, USA
| | - Tracey Sweeney
- Department of Pharmacy, 2090University of Vermont Medical Center, Burlington, VT, USA
| | - Molly Trayah
- Department of Pharmacy, 2090University of Vermont Medical Center, Burlington, VT, USA
| | - Maria Civalier
- Department of Pharmacy, 2090University of Vermont Medical Center, Burlington, VT, USA
| | - Wesley McMillian
- Department of Pharmacy, 2090University of Vermont Medical Center, Burlington, VT, USA
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11
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Franckowiak TM, Raub JN, Yost R. Derivation and validation of a hospital all-cause 30-day readmission index. Am J Health Syst Pharm 2019; 76:436-443. [DOI: 10.1093/ajhp/zxy085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Taylor M Franckowiak
- Department of Pharmacy Services, St. Mary Mercy Hospital, Livonia, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Joshua N Raub
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Raymond Yost
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
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12
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McConachie SM, Raub JN, Trupianio D, Yost R. Development of an iterative validation process for a 30-day hospital readmission prediction index. Am J Health Syst Pharm 2019; 76:444-452. [PMID: 31361819 DOI: 10.1093/ajhp/zxy086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE A study was conducted to determine if an iterative validation process could maintain or improve the discriminative and predictive capabilities of a 30-day hospital readmission prediction index over 2.5 years. METHODS Patient admissions were retrospectively identified using the electronic medical record. The receiver operating characteristic curve was used to assess model discrimination. Prediction index specificity, sensitivity, and positive and negative predictive values were also assessed. A rolling iterative validation process was developed in which patient admissions were divided into 3-month cohorts. Each cohort was analyzed individually and then included into the cumulative patient cohort and analyzed again. RESULTS From 121,277 patient visits, an iterative validation approach maintained the discrimination (0.71 to 0.72), predictive validity, and overall accuracy (80.9% to 81.7%) of the 30-day readmission prediction index over 2.5 years. Index sensitivity and negative predictive value increased from baseline while specificity and positive predictive value remained largely unchanged. None of the assessed index parameters diminished or became less useful over the course of the study. CONCLUSION An internal iterative validation process based on frequentist statistics maintained the discriminative ability and accuracy of a readmission index over 2.5 years despite numerous changes in the variables associated with readmission in the patient population.
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Affiliation(s)
- Sean M McConachie
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, and Transitions of Care, Detroit, MI
| | - Joshua N Raub
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy Detroit, MI,and Health Sciences, Wayne State University, Detroit, MI
| | - David Trupianio
- Harper University Hospital, Detroit Medical Center, Detroit, MI
| | - Raymond Yost
- Department of Pharmacy Services, Detroit Medical Center, Detroit, MI, and Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
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13
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McDerby N, Kosari S, Bail KS, Shield AJ, Thorpe R, Naunton M. Residential care pharmacists: another hole plugged in the Swiss cheese. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nicole McDerby
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Sam Kosari
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Kasia S. Bail
- Discipline of Nursing; Faculty of Health; University of Canberra; Canberra Australia
| | - Alison J. Shield
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Richard Thorpe
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
| | - Mark Naunton
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Canberra Australia
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Zullo AR, Lou U, Cabral SE, Huynh J, Berard-Collins CM. Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia. J Oncol Pharm Pract 2018; 25:1357-1365. [PMID: 30124123 DOI: 10.1177/1078155218792698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. METHODS We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. RESULTS We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6-62.7) and suggested that 31% (95% CI: 8%-71%) of the variation in use was attributable to physician characteristics. CONCLUSION Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.
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Affiliation(s)
- Andrew R Zullo
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA.,2 Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA.,3 Department of Epidemiology, Brown University, Providence, RI, USA.,4 Providence Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, RI, USA
| | - Uvette Lou
- 5 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Cabral
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Justin Huynh
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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