The Annals of pharmacotherapy最新文献

{"title":"Comment: Neuroleptic malignant syndrome versus serotonin syndrome: the search for a diagnostic tool.","authors":"Michael A Darracq","doi":"10.1345/aph.1P787a","DOIUrl":"https://doi.org/10.1345/aph.1P787a","url":null,"abstract":"one other report of a patient in whom a hepatorenal syndrome developed; thisoccurred10 monthsaftercelecoxibwas started/ In that case, biopsyspecimens showedcholestasis and tubularnephritis, and a hypersensitivityreactionwas postulated. An allergicor idiosyncratic mechanismtriggered by celecoxib is alsoprobable in our patient. Celecoxib-inducedhepatotoxicity mayhavea hepatocellular, cholestatic, or combined pattern,whereasnephrotoxicity has been described as interstitial (tubular) nephritis,nephritic syndrome,membranous glomerulopathy, papillary necrosis, and acute renal failure (reviewed by Tabibian and colleagues'). We underscore the need for close clinical and biochemical surveillance,particularly if celecoxib is givento individuals withriskfactors for liveror kidneydysfunction.","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"611-2; author reply 613"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1P787a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40162232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholinesterase inhibitor adjunctive therapy for cognitive impairment and depressive symptoms in older adults with depression.","authors":"Cara L McDermott,&nbsp;Shelly L Gray","doi":"10.1345/aph.1Q445","DOIUrl":"https://doi.org/10.1345/aph.1Q445","url":null,"abstract":"<p><strong>Objective: </strong>To review the primary literature regarding the use of cholinesterase inhibitors (ChEIs) as adjunctive therapy for cognitive enhancement and improvement of depressive symptoms for older adults with depression.</p><p><strong>Data sources: </strong>A literature search of MEDLINE (1950-September 2011) was conducted, using the search term depression in combination with cholinesterase inhibitor, donepezil, galantamine, or rivastigmine. A search of reference citations was conducted to identify additional references.</p><p><strong>Study selection and data extraction: </strong>English-language clinical trials were evaluated. Studies that included subjects with Alzheimer's disease, dementia, Parkinson disease, bipolar disorder, or schizophrenia were excluded. Four clinical studies met our criteria.</p><p><strong>Data synthesis: </strong>We identified 4 randomized, double-blind, placebo-controlled trials that ranged in sample size from 20 to 130. Galantamine 16 mg daily was evaluated in 2 trials lasting 8 and 24 weeks. Neither study found a statistically significant difference in measures of cognition or Hamilton Rating Scale for Depression scores. Donepezil augmentation was evaluated in a 1-year and a 2-year trial. Donepezil was found to improve global cognition at 1 year, but the benefit did not persist at year 2. Subjects with mild cognitive impairment at baseline who received donepezil experienced higher depression recurrence than did those who took placebo (p = 0.03); this effect was not observed in cognitively intact subjects (p = 0.39).</p><p><strong>Conclusions: </strong>There is no clear benefit for ChEI therapy as an adjunct to antidepressant therapy for depressed older adults.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"599-605"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40162233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment: Neuroleptic malignant syndrome versus serotonin syndrome: the search for a diagnostic tool.","authors":"Hossein Sanaei-Zadeh","doi":"10.1345/aph.1P787b","DOIUrl":"https://doi.org/10.1345/aph.1P787b","url":null,"abstract":"suggested by the authors are of little clinical value because of the turnaroundtime associatedwith their return and challengesin interpretation. In the end, the distinction between serotonin syndrome and NMS reflectsdifferentcauses, but the treatment is the same for both.The decision as to which antidoteto initiateis of littleclinical importance,as evidence for the use of theseantidotesis sparse and conflicting.I urge medical practitioners to exercise caution in the use of dantrolene because it may in fact be harmful to patients with NMS. The evidence supporting the use of cyproheptadine in serotoninsyndromeis limitedat best.","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"612; author reply 613"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1P787b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40162234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge for geriatric patients.","authors":"Pieter Cornu,&nbsp;Stephane Steurbaut,&nbsp;Tinne Leysen,&nbsp;Eva De Baere,&nbsp;Claudine Ligneel,&nbsp;Tony Mets,&nbsp;Alain G Dupont","doi":"10.1345/aph.1Q594","DOIUrl":"https://doi.org/10.1345/aph.1Q594","url":null,"abstract":"<p><strong>Background: </strong>Medication discrepancies have the potential to cause harm. Medication reconciliation by clinical pharmacists aims to prevent discrepancies and other drug-related problems.</p><p><strong>Objective: </strong>To determine how often discrepancies in the physician-acquired medication history result in discrepancies during hospitalization and at discharge. Secondary objectives were to determine the influence of clinical pharmacists' interventions on discrepancies and to investigate possible patient-related determinants for experiencing discrepancies.</p><p><strong>Methods: </strong>This was a retrospective, single-center, cohort study of patients who were admitted to the acute geriatric department of a Belgian university hospital and followed up by clinical pharmacists between September 2009 and April 2010. Patients were limited to those 65 years or older who were taking 1 or more prescription drug. Medication reconciliation at admission, during hospitalization, and at discharge was conducted by an independent pharmacist who gathered information via chart reviews.</p><p><strong>Results: </strong>The reconciliation process at admission identified 681 discrepancies in 199 patients. Approximately 81.9% (163) of patients had at least 1 discrepancy in the physician-acquired medication history. The clinical pharmacists performed 386 interventions, which were accepted in 279 cases (72.3%). A quarter of the medication history discrepancies (165; 24.2%) resulted in discrepancies during hospitalization, mostly because the intervention was not accepted. At discharge, 278 medication history discrepancies (40.8%) resulted in discrepancies in the discharge letter, accounting for 50.2% of all 554 discrepancies identified in the discharge letters. The likelihood for experiencing discrepancies at admission increased by 47% for every additional drug listed in the medication history.</p><p><strong>Conclusions: </strong>Discrepancies in the physician-acquired medication history at admission do not always correlate with discrepancies during hospitalization because of clinical pharmacists' interventions; however, discrepancies at admission may be associated with at least half of the discrepancies at discharge. Clinical pharmacist-conducted medication reconciliation can reduce these discrepancies, provided the erroneous information in the physician-acquired medication history is corrected and each intentional change in the medication plan is well documented during hospitalization and at discharge.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"484-94"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40162235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the difference in preventive vaccination uptake in patients with diabetes mellitus.","authors":"Anna M Dunlap,&nbsp;Amy W Rudenko","doi":"10.1345/aph.1Q409","DOIUrl":"https://doi.org/10.1345/aph.1Q409","url":null,"abstract":"TO THE EDITOR: According to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices, yearly vaccination for seasonal influenza, as well as vaccination with the pneumococcal vaccine, has the potential to significantly reduce morbidity and mortality in patients with diabetes.1 People with diabetes may have abnormal immune function, which puts them at an increased risk for complications, hospitalizations, and death from pneumococcal disease or influenza. Healthy People 2020 set goals specifically for vaccination in high-risk adults (including diabetic patients) of 90% for seasonal influenza and 60% for pneumococcal disease.2 At baseline, vaccination rates are at 39% and 17%, respectively. If goals are unmet, health care professionals will need to gain an understanding of why these patients are not vaccinated and then develop ways to increase vaccination in the future. The objective of our survey was to evaluate preventive vaccination uptake in diabetic patients and identify reasons related to their vaccination decisions. Methods. A survey was designed to evaluate preventive vaccination rates in diabetic patients patronizing a mass merchandiser community pharmacy. The survey assessed the reasons for patient vaccination decisions and was adapted from a CDC survey evaluating similar information for Medicare beneficiaries.3 All diabetic patients over the age of 18 receiving prescriptions were identified as possible participants in this institutional review board–approved survey. The χ2 test was used to analyze data. Results. Seventy-six of 240 patients completed the survey, for a response rate of 31.7%. Approximately 29% of patients were not getting a yearly influenza vaccine and 39% of patients had not received the pneumococcal vaccine. Fewer patients who were younger than 65 years old had received the pneumococcal vaccine compared to patients 65 years or older (p = 0.02). A summary of reasons identified for vaccination decisions is included in Table 1. Discussion. From our results, we have concluded that patients who are younger than 65 years tend to be more likely to recognize that they are at high risk of complications from influenza and pneumococcal disease; however, their vaccination rates tend to be lower than those of patients who are over 65. Patients aged 65 and over have a higher rate of vaccination, but are vaccinated because of their age, not recognizing that having diabetes and being older puts them into a high-risk category. The results of our survey are similar to findings of the CDC survey of Medicare beneficiaries concerning reasons for not receiving the influenza and pneumococcal vaccinations.3 Limitations to our study include the fact that we were not able to evaluate a difference between patients with type 1 and those with type 2 diabetes, as there could be a perceived difference in risk based on type of diabetes. As pharmacists who work in a variety of practice areas, we should consider edu","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"609-10"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40162231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mosquirix (RTS,S): a novel vaccine for the prevention of Plasmodium falciparum malaria.","authors":"Kyle J Wilby,&nbsp;Tim T Y Lau,&nbsp;Samuel E Gilchrist,&nbsp;Mary H H Ensom","doi":"10.1345/aph.1AQ634","DOIUrl":"https://doi.org/10.1345/aph.1AQ634","url":null,"abstract":"<p><strong>Objective: </strong>To summarize and evaluate the literature for Mosquirix (RTS,S) and provide insight into the therapeutic and economic controversies of this novel malaria vaccine candidate.</p><p><strong>Data sources: </strong>A systematic literature search was performed using the terms Mosquirix; RTS,S; malaria; vaccine; and Plasmodium in MEDLINE (1948-November 2011), EMBASE (1980-November 2011), International Pharmaceutical Abstracts (1970-November 2011), Google, and Google Scholar.</p><p><strong>Study selection and data extraction: </strong>Clinical trials describing vaccine development, pharmacology, pharmacokinetics, efficacy, and safety were reviewed. For efficacy, clinical trials were reviewed that reported acquisition of malarial disease. Information regarding study design, population, study period, baseline characteristics, clinical outcomes, results, and assessors of quality was extracted.</p><p><strong>Data synthesis: </strong>Five randomized controlled trials and 4 follow-up extension studies were identified. In Phase 2 trials, vaccine efficacy rates were 33-65% in infants and 30-53% in children for preventing the first episode of clinical disease. In Phase 3 trials, vaccine efficacy was 56% in children aged 5-17 months. RTS,S reduced the number of clinical malaria episodes and prevented severe malaria in several studies. The follow-up period for vaccine efficacy ranged from 6 to 45 months. RTS,S 25 μg is administered intramuscularly as 3 injections given 1 month apart for infants and children. RTS,S appears to be generally well tolerated. A few cases of meningitis and seizures (within 7 days of vaccination) have been reported.</p><p><strong>Conclusions: </strong>RTS,S has demonstrated efficacy and safety in Phase 1, 2, and 3 trials, and has the potential to decrease morbidity and mortality from malaria worldwide. Major challenges include determination of the duration of immunity, assessment of its cost-effectiveness, its use in special populations, and its dissemination in endemic regions. Pending further studies, RTS,S has the potential to become the benchmark as the first effective vaccine against malaria.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"384-93"},"PeriodicalIF":2.9,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1AQ634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40155826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pegloticase: a novel agent for treatment-refractory gout.","authors":"Jennifer A Shannon,&nbsp;Sabrina W Cole","doi":"10.1345/aph.1Q593","DOIUrl":"https://doi.org/10.1345/aph.1Q593","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate efficacy and safety of pegloticase, approved by the Food and Drug Administration in September 2010 for treatment of patients with chronic treatment-refractory gout.</p><p><strong>Data sources: </strong>Literature searches were conducted using PubMed (1948-January 2012), TOXLINE, International Pharmaceutical Abstracts (1970-January 2012), and Google Scholar using the terms pegloticase, puricase, PEG-uricase, gout, uricase, and Krystexxa. Results were limited to English-language publications. References from selected articles were reviewed to identify additional citations.</p><p><strong>Study selection and data extraction: </strong>Studies evaluating the pharmacology, pharmacokinetics, safety, and efficacy of pegloticase for the treatment of chronic treatment-refractory gout were included.</p><p><strong>Data synthesis: </strong>Pegloticase represents a novel intravenous treatment option for patients who have chronic gout refractory to other available treatments. Pegloticase is a recombinant uricase and achieves therapeutic effects by catalyzing oxidation of uric acid to allantoin, resulting in decreased uric acid concentrations. Results of published trials demonstrate the ability of pegloticase to maintain uric acid concentrations below 7 mg/dL in patients with chronic gout. Data supporting reduction of gout flares are limited. Pegloticase is well tolerated but associated with gout flares and infusion reactions. Other adverse events include nausea, dizziness, and back pain. During Phase 3 trials, 2 patients in the pegloticase biweekly group and 1 in the monthly group experienced heart failure exacerbation; another patient in the monthly group experienced a nonfatal myocardial infarction. Providers should exercise caution before administering pegloticase to patients with cardiovascular disease. The cost burden and safety profile may limit its use in practice, in addition to limited data available to support decreases in patient-centered outcomes (eg, gouty attacks).</p><p><strong>Conclusions: </strong>Pegloticase is an effective option for patients with symptomatic gout for whom current uric acid-lowering therapies are ineffective or contraindicated.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"368-76"},"PeriodicalIF":2.9,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40145422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of body size descriptors on the estimation of kidney function in normal weight, overweight, obese, and morbidly obese adults.","authors":"Eun Jung Park,&nbsp;Manjunath P Pai,&nbsp;Ting Dong,&nbsp;Jialu Zhang,&nbsp;Chia-Wen Ko,&nbsp;John Lawrence,&nbsp;Victor Crentsil,&nbsp;Lei Zhang,&nbsp;Nancy N Xu","doi":"10.1345/aph.1Q374","DOIUrl":"https://doi.org/10.1345/aph.1Q374","url":null,"abstract":"<p><strong>Background: </strong>Dosing adjustments for patients with impaired kidney function are often based on estimated creatinine clearance (eCrCl) because measuring kidney function is not always possible for dose adjustment. However, there is no consensus on the body size descriptor that should be used in the estimation equations.</p><p><strong>Objective: </strong>To compare the use of alternative body size descriptors (ABSDs) on the performance of kidney function estimation equations compared with measured CrCl (mCrCl).</p><p><strong>Methods: </strong>We combined 2</p><p><strong>Data sources: </strong>a Food and Drug Administration clinical trial database that includes subjects with body mass index (BMI) less than 40 kg/m(2) and published data from those 40 kg/m(2) or more. The 3 parent equations (Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], Chronic Kidney Disease-Epidemiology Collaboration [CKDEPI]), and 14 ABSD-modified equations were compared with mCrCl for accuracy, bias, agreement, goodness of fit (R(2)), and prediction error. These equations were also compared across mCrCl and BMI strata.</p><p><strong>Results: </strong>Subjects (n = 590) were aged 19-80 years; 33.9% were female and BMI ranged from 17.2 to 95.6 kg/m(2). Compared with mCrCl, the use of total weight in the CG equation yielded low accuracy (12.5%) and significant bias (-107 mL/min) in the morbidly obese group. In contrast, the use of lean body weights (BMI ≥40 kg/m(2)) and total ± adjusted weights (BMI <40 kg/m(2)) with the CG equation yielded higher accuracy, greater than or equal to 60.7% across all BMI strata, and was unbiased. Transforming the MDRD or CKDEPI equations with body surface area improved accuracy only at mCrCl of 30-80 mL/min and increased the overall prediction error.</p><p><strong>Conclusions: </strong>No kidney function equation was consistently accurate and unbiased across weight, mCrCl, and estimate ranges. The accuracy and overestimation bias of the CG equation in obese subjects was improved through the selective use of total, adjusted, and lean body weight by BMI strata.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"317-28"},"PeriodicalIF":2.9,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40145471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of clinical pharmacist intervention on diabetes-related outcomes in a military treatment facility.","authors":"Stephanie Wallgren,&nbsp;Cristóbal S Berry-Cabán,&nbsp;Laura Bowers","doi":"10.1345/aph.1Q564","DOIUrl":"https://doi.org/10.1345/aph.1Q564","url":null,"abstract":"<p><strong>Background: </strong>Clinical pharmacist management of patients with diabetes has been well justified, but there is a lack of research that evaluates the impact of pharmacist-managed diabetes care versus standard medical care on American Diabetes Association (ADA) treatment goals other than hemoglobin A(1c) (A1C).</p><p><strong>Objective: </strong>To evaluate the reduction in A1C, blood pressure, and low-density lipoprotein cholesterol (LDL-C) for patients with diabetes whose care was managed by a clinical pharmacist and compare these values to those of a cohort of patients whose care was managed by primary care providers. The difference in percentage of patients attaining ADA treatment goals between the 2 groups was also evaluated.</p><p><strong>Methods: </strong>This retrospective chart review identified 98 diabetic patients managed by a clinical pharmacist with at least 2 A1C measurements between September 15, 2008, and March 15, 2011. The Military Health System Population Health Portal was used to identify a similar group of patients with diabetes managed by their primary care provider (N = 90). The Armed Forces Health Longitudinal Technology Application was used to collect baseline data and the most recent measurements for A1C, blood pressure, LDL-C, and documented immunizations.</p><p><strong>Results: </strong>The pharmacist group saw positive improvements in all primary end points, including a 1.6% reduction in A1C, a 9-mm Hg and 1.4-mm Hg reduction in systolic and diastolic blood pressure, respectively, and a 16.3-mg/dL reduction in LDL-C. Conversely, the control group had an increase of 0.8% in A1C and 1.5 mm Hg in diastolic blood pressure. Reductions in systolic blood pressure and LDL-C were much less robust than in the pharmacist group (1.6 mm Hg and 5.2 mg/dL, respectively). Overall, patients in the pharmacist group were more likely to achieve ADA treatment goals.</p><p><strong>Conclusion: </strong>Pharmacist management of patients with diabetes significantly reduces A1C and allows more patients to meet ADA treatment goals. A clinical pharmacist-run diabetes clinic can provide numerous clinical benefits to patients.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"353-7"},"PeriodicalIF":2.9,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q564","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40145475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.","authors":"Fatma Karapinar-Çarkit,&nbsp;Sander D Borgsteede,&nbsp;Jan Zoer,&nbsp;Toine C G Egberts,&nbsp;Patricia M L A van den Bemt,&nbsp;Maurits van Tulder","doi":"10.1345/aph.1Q520","DOIUrl":"https://doi.org/10.1345/aph.1Q520","url":null,"abstract":"<p><strong>Background: </strong>Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.</p><p><strong>Objective: </strong>To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.</p><p><strong>Methods: </strong>A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.</p><p><strong>Results: </strong>Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).</p><p><strong>Conclusions: </strong>Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"329-38"},"PeriodicalIF":2.9,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40145421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}