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Qoua L Her, Mary G Amato, Diane L Seger, James F Gilmore, John Fanikos, Julie M Fiskio, David W Bates
BACKGROUND: The Joint Commission requires hospitals to formally review formulary medications at least annually based on new clinical information. Although review of nonformulary medication (NFM) use is not required, frequent and inappropriate use of NFMs has the potential to increase hospital costs, negatively affect quality of care, and increase medication errors. Limited resources may restrict an institution's ability to review NFM use in addition to the required annual formulary review...
February 2017: Joint Commission Journal on Quality and Patient Safety
Walid F Gellad, Francesca E Cunningham, Chester B Good, Joshua M Thorpe, Carolyn T Thorpe, Brandi Bair, KatieLynn Roman, Susan L Zickmund
BACKGROUND: The Veterans Choice Program (VCP) was created to ensure timely access to health care in the Department of Veterans Affairs (VA). Under this program, medications may be ordered by select non-VA clinicians to be dispensed by VA pharmacies, creating new challenges in ensuring medication safety. OBJECTIVES: To examine pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP...
February 17, 2017: Medical Care
Daoud Al-Badriyeh, Ibrahim Alabbadi, Michael Fahey, Abdullatif Al-Khal, Manal Zaidan
PURPOSE: The formulary inclusion of proton pump inhibitors (PPIs) in the government hospital health services in Qatar is not comparative or restricted. Requests to include a PPI in the formulary are typically accepted if evidence of efficacy and tolerability is presented. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar or the Middle East. This study aims to compare first-line use of the PPIs that exist in Qatar...
2016: Clinical Therapeutics
Thomas R Radomski, Chester B Good, Carolyn T Thorpe, Xinhua Zhao, Zachary A Marcum, Peter A Glassman, John Lowe, Maria K Mor, Michael J Fine, Walid F Gellad
BACKGROUND: All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists across facilities. Local management of the national formulary may differ across VAMCs and may be one cause of this variation. OBJECTIVE: To characterize variation in the management of nonformulary medication requests and pharmacy and therapeutics (P&T) committee member perceptions of the formulary environment at VAMCs nationwide...
February 2016: Journal of Managed Care & Specialty Pharmacy
Qoua L Her, Mary G Amato, Diane L Seger, Patrick E Beeler, Sarah P Slight, Olivia Dalleur, Patricia C Dykes, James F Gilmore, John Fanikos, Julie M Fiskio, David W Bates
BACKGROUND: Experts suggest that formulary alerts at the time of medication order entry are the most effective form of clinical decision support to automate formulary management. OBJECTIVE: Our objectives were to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved. METHODS: Alert overrides of the top 11 (n = 206) most-utilized and highest-costing NFMs, from January 1 to December 31, 2012, were randomly selected for appropriateness evaluation...
September 2016: Journal of the American Medical Informatics Association: JAMIA
Joao Correia De Pinho, Lusine Aghajanova, Christopher N Herndon
BACKGROUND: Gynecomastia is a disorder of the endocrine system characterized by an abnormal presence of a palpable unilateral or bilateral enlargement and proliferation of glandular ductal benign breast tissue in male individuals. This case discusses the medical implications of an unregulated, indirect exposure to nonformulary, bioidentical hormone replacement therapy in male children. CASE: An 8-year-old boy presented with prepubertal gynecomastia secondary to estrogen exposure from maternal use of bioidentical hormonal replacement therapy (the Wiley protocol)...
January 2016: Journal of Reproductive Medicine
Qoua L Her, Diane L Seger, Mary G Amato, Patrick E Beeler, Olivia Dalleur, Sarah P Slight, Patricia C Dykes, David W Bates
PURPOSE: An algorithm for assessing the appropriateness of physician overrides of clinical decision support alerts triggered by nonformulary medication (NFM) requests is described. METHODS: Data on a random sample of 5000 NFM alert overrides at Brigham and Women's Hospital over a four-year period (2009-12) were extracted from the hospital's computerized prescriber-order-entry (CPOE) system. Through an iterative process, a scheme for categorizing the reasons given by prescribers for alert overrides was developed...
January 1, 2016: American Journal of Health-system Pharmacy: AJHP
Gregory Krauss, Sherry Sandy, David O C Corbin, Jacqueline Bird-Compton, Frances Jack, Beverly Nelson, Tuula O Jalonen, Amza Ali, Taryn Fortuné, Dave Clarke, Jacqueline Okolie, Mackenzie C Cervenka
Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes...
October 2015: Epilepsy & Behavior: E&B
Daoud Al-Badriyeh, Michael Fahey, Ibrahim Alabbadi, Abdullatif Al-Khal, Manal Zaidan
PURPOSE: Statin selection for the largest hospital formulary in Qatar is not systematic, not comparative, and does not consider the multi-indication nature of statins. There are no reports in the literature of multi-indication-based comparative scoring models of statins or of statin selection criteria weights that are based primarily on local clinicians' preferences and experiences. This study sought to comparatively evaluate statins for first-line therapy in Qatar, and to quantify the economic impact of this...
December 1, 2015: Clinical Therapeutics
Alicia A Bergman, Heather A Jaynes, Jasmine D Gonzalvo, Karen Suchanek Hudmon, Richard M Frankel, Amanda L Kobylinski, Alan J Zillich
Expanded clinical pharmacist professional roles in the team-based patient-centered medical home (PCMH) primary care environment require cooperative and collaborative relationships among pharmacists and primary care physicians (PCPs), but many PCPs have not previously worked in such a direct fashion with pharmacists. Additional roles, including formulary control, add further elements of complexity to the clinical pharmacist-PCP relationship that are not well described. Our objective was to characterize the nature of clinical pharmacist-PCP interprofessional collaboration across seven federally funded hospitals and associated primary care clinics, following pharmacist placement in primary care clinics and incorporation of expanded pharmacist roles...
2016: Health Communication
Miranda R Andrus, Jeanne B Forrester, Kenda E Germain, Lea S Eiland
BACKGROUND: Physicians commonly use formulary medication coverage information generated by electronic heath records (EHRs) and the Epocrates mobile drug database application when making medication selection decisions. Nonformulary selections may lead to higher out-of-pocket patient costs and nonadherence with prescribed regimens. Nonformulary selections also contribute to higher overall health plan spending. However, the accuracy of these systems compared with actual insurance coverage is not known...
April 2015: Journal of Managed Care & Specialty Pharmacy
Pieter J Helmons, Carrie R Coates, Jos G W Kosterink, Charles E Daniels
PURPOSE: Study results demonstrating the effectiveness of order-entry clinical decision support (CDS) alerts as a tool for enforcing therapeutic interchange are presented. METHODS: A retrospective observational study was conducted at an academic medical center to evaluate formulary nonadherence before and after implementation of a fully electronic medical record with computerized prescriber order-entry (CPOE) technology configured to display therapeutic interchange alerts immediately on entry of orders for nonformulary agents...
March 1, 2015: American Journal of Health-system Pharmacy: AJHP
Zackary Berger, William Kimbrough, Colleen Gillespie, Joseph A Boscarino, G Craig Wood, Zhengmin Qian, J B Jones, Nirav R Shah
BACKGROUND: Nonadherence to asthma medications is associated with increased emergency department visits and hospitalizations. If adherence is to be improved, first-fill adherence is the first goal to meet after the physician and patient have decided to begin treatment. Little is known about first-fill adherence with asthma medications and the factors for no-fill. OBJECTIVE: The goal of the study was to examine the proportion of patients who fill a new prescription for an asthma medication and analyze characteristics associated with this first-fill...
June 2009: American Health & Drug Benefits
Sarah Glaholt, Genevieve L Hayes, Christopher S Wisniewski
OBJECTIVE: Automatic therapeutic substitution (ATS) is a mechanism that, upon patient hospitalization, prompts the pharmacist to exchange an equivalent formulary drug for a nonformulary medication, typically without prescriber contact. In facilities utilizing ATS, there is the possibility that physicians and patients may be unaware of the substitution, potentially leading to drug-drug interactions, therapeutic duplication, and/or increased patient expense following discharge should the original regimen not be resumed...
April 2014: P & T: a Peer-reviewed Journal for Formulary Management
Pieter J Helmons, Jos G W Kosterink, Charles E Daniels
PURPOSE: The impact of a comprehensive hospital formulary management system on formulary compliance and pharmacy labor costs was evaluated. METHODS: The formulary management system consisted of monitoring nonformulary medication use, reviewing formulary medication use annually, and providing periodic feedback. Workflow scenarios for nonformulary medication requests were identified. Pharmacy personnel were interviewed to obtain the probability of occurrence of each scenario and the time involved...
March 1, 2014: American Journal of Health-system Pharmacy: AJHP
Beth Bryles Phillips, Kim C Williams
PURPOSE: The implementation of an innovative ambulatory care pharmacy residency program at a Veterans Affairs (VA) outpatient clinic is described. SUMMARY: Community-based outpatient clinics (CBOCs) are a largely underutilized resource for pharmacy residency training. Through a collaboration of the University of Georgia College of Pharmacy in Athens and Charlie Norwood VA Medical Center in Augusta, a postgraduate year 2 (PGY2) pharmacy residency program was established at the CBOC in Athens...
May 15, 2012: American Journal of Health-system Pharmacy: AJHP
Matthew S Davies, Munro B Robertson, Stewart H A Brown, Bethan Saunders, W Stephen Waring
PURPOSE: Clinical guidelines concerning treatment of infection are incorporated into prescribing formularies and antimicrobial stewardship policies. The extent to which these influence prescribing is uncertain. In this study, we sought to examine antimicrobial prescribing patterns in patients with cellulitis. METHODS: Consecutive adults admitted to hospital due to acute cellulitis between 2008 and 2010 were studied. Data collected were clinical and laboratory markers of sepsis, antimicrobial agent, route of administration, number of i...
September 2012: European Journal of Clinical Pharmacology
John-Michael Gamble, Finlay A McAlister, Jeffrey A Johnson, Dean T Eurich
OBJECTIVE: Drug exposure misclassification may occur in administrative databases when individuals obtain nonreimbursed drugs by paying "out-of-pocket" or via alternative drug coverage plans. We examined the apparent association between oral antidiabetic therapy and mortality by simulating the effects of restrictive drug coverage policies. METHODS: Population-based cohort study of 12,272 new patients using oral antidiabetic agents were identified using the administrative databases of Saskatchewan Health, 1991 to 1996...
January 2012: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Adewale B Ajumobi, Ronald Vuong, Hycienth Ahaneku
BACKGROUND: In the Veterans Affairs (VA) health care system, a formulary-based approach without beneficiary cost-share incentives is used to limit the pharmacy cost of proton pump inhibitors (PPIs). However, the effectiveness of this approach in reducing the cost of PPIs is unknown. OBJECTIVES: To (a) compare cost differences between the formulary PPI (generic omeprazole) and nonformulary PPIs and (b) evaluate reasons for nonformulary PPI use in order to identify opportunities to increase formulary drug use and discourage unnecessary use of nonformulary PPIs...
January 2012: Journal of Managed Care Pharmacy: JMCP
Jessica L Milchak, Roberta L Shanahan, Jane A Kerzee
BACKGROUND: Kaiser Permanente Colorado is a group model nonprofit HMO that provides health care services to more than 500,000 members. The Primary Care Clinical Pharmacy Services (PCCPS) department consists of 33 clinical pharmacy specialists (CPS), who are located in 19 primary care clinics. OBJECTIVES: To develop and implement a peer review process to (a) improve the consistency of documentation of process indicators in the electronic medical record (EMR), (b) ensure compliance with existing standards, and (c) share best practices among PCCPS with varying geographical locations and practice styles...
January 2012: Journal of Managed Care Pharmacy: JMCP
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