Latest Clinical Research Findings in 2001

LATEST CLINICAL RESEARCH FINDINGS

An Evaluation of Nursing Perceptions of the Consultant Pharmacist in the Long-term Care Setting /
Impact of a Pharmacist on Drug Costs in a Coronary Care Unit /
Compatibility of Spacers With Metered-Dose Inhalers /
Converting Patients From Brand-Name Clozapine to Generic Clozapine /
Performance of Community Pharmacy Drug Interaction Software /
Comparison of Length of Hospital Stay for Patients With Known or Suspected Methicillin-Resistant

From
The Consultant Pharmacist
March 2001 (Volume 16, Number 3)

An Evaluation of Nursing Perceptions of the Consultant Pharmacist in the Long-term Care Setting
Yerondopoulos R, Rhoads M, Herrier RN
Consult Pharm. 2001;16:269-276
Of the healthcare team members in long-term care facilities, nurses are the primary contact for the consultant pharmacist. Nursing perceptions can influence the effectiveness of achieving desired patient outcomes. This study used a survey to evaluate, on a small scale, nursing perceptions of consultant pharmacists. The survey was administered to 195 nurses at 7 long-term care facilities.
A 28-question survey was used. The majority of the questions were designed to address specific consultant pharmacist roles (18 questions). The remainder addressed specifically the pharmacist/nurse relationship.
A total of 54 complete responses were received, with a response rate of 27.6%. Both licensed practical nurses and registered nurses responded to the survey. Three different consultant pharmacists provided services to the surveyed facilities. Responses to statements were quantified using a 6-point Likert scale. In general, nurses agreed with all of the function statements and had a positive perception of the consultant pharmacist. Overall, the nurses felt that the pharmacist most often aided the facility in meeting governmental and regulatory standards.

Editor's Comment

This survey represents a small sample, but reinforces the common-sense notion that enlisting support from all healthcare team members is important for effective patient care. In many practice settings, the focus of attention is on the prescriber, as this is an important conduit to improving patient medication therapy. Often, pharmacists forget about the importance of the caregiver and the impact that he/she can have on the long-term achievement of positive health outcomes. Even small studies like this can serve as effective reminders.

From
American Journal of Health-System Pharmacy
March 15, 2001 (Volume 58, Number 6)

Impact of a Pharmacist on Drug Costs in a Coronary Care Unit

Gandhi PJ, Smith BS, Tataronis GR, Maas B
Am J Health Syst Pharm. 2001;58:497-503

In one coronary care unit (CCU), drug costs increased by 54% over a 1-year period. Clinical pharmacy services were initiated soon after that increase was noted. Approximately 50% of the clinicians' time is spent in the 14-bed CCU.
Mean drug costs per admission were followed prior to initiation of clinical pharmacy services and in 2 subsequent periods. Six categories of drugs were identified and tracked. Based on prior literature reports, it was expected that a 5% reduction in drug costs per admission would be noted in each of the 2 intervention periods.
Total numbers of patients admitted to the CCU were 898 for the nonintervention period and 960 and 1021 for each of the subsequent intervention periods. A significantly lower mean drug cost per admission was seen for the second intervention period as compared with the nonintervention period (P = .002) and the first intervention period (P = .001). Total hospital costs were also significantly decreased in the same period.

Editor's Comment

Despite the advent of new and more costly cardiac therapies, the presence of a clinical pharmacist had an impact on overall drug costs. This information can be added to the growing literature on the impact these professionals can have on healthcare costs. As always, it seems that this article is published in a journal in which the authors are preaching to the choir. In order for this information to be effective, pharmacists will have to be willing to publish in nonpharmacy-related journals.

Abstract
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From
American Journal of Health-System Pharmacy
April 1, 2001 (Volume 58, Number 7)

Compatibility of Spacers With Metered-Dose Inhalers
Lakamp RE, Berry TM, Prosser TR, et al.
Am J Health Syst Pharm. 2001;58:585-591

The correct use of metered-dose inhalers (MDIs) continues to be a concern. Coordination of actuation and inhalation can be difficult for most patients, especially those in the pediatric and geriatric populations. The use of spacer devices can help assist patients with the administration of an inhaled medication. Several spacers are currently available on the market. The investigators in this study compared the currently available spacers and identified features that could be used to help with product selection.
A total of 11 spacers and 20 MDIs were included in the comparison. Spacers were evaluated for compatibility with each MDI, ease of use, acquisition and replacement costs, durability, portability, utility of patient instructions, and special features. All spacers tested were incompatible with at least 1 MDI. All spacers included instructions for use in the English language and 3 included Spanish directions. Instructions for cleaning were available for each product, although recommendations on the timing of replacement were not provided for 6 of the products.

Editor's Comment

This article provides important comparative information on the available spacer devices. The use of a spacer can help improve patient care if the drug is delivered more effectively. However, effective medication use cannot occur if the spacer is incompatible with the MDI or the cost of the device is prohibitive. Reviews such as this should be used to help in product selection.

Abstract
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From
The Annals of Pharmacotherapy
March 2001 (Volume 35, Number 3)

Converting Patients From Brand-Name Clozapine to Generic Clozapine

Sajbel TA, Carter GW, Wiley RB
Ann Pharmacother. 2001;35:281-284
In a large psychiatric hospital in Colorado, atypical antipsychotics represented a large part of the pharmacy budget. Since 1990, approximately 600 patients at the facility were treated with clozapine. Significant costs were associated with the use of the brand-name drug. This study was conducted to evaluate the dosages and safety of conversion of patients from the brand-name clozapine product to an AB-rated generic product.
All patients treated with brand-name clozapine were converted to generic clozapine. Data from 17 patients were included in this study. All patients had been stable on the brand-name product for a period of 3 years. White blood cell counts (WBC) were evaluated. Although specific psychiatric analyses were not performed, dosing changes were monitored and believed to reflect changes in the patients' clinical condition. There were no differences noted in the WBC obtained before and after the product change (P = .9992). Dosage data for the 2 products were compared using a Brown-Forsythe test. No significant differences in dosage requirements between the 2 products were noted for the 3-year data or the 1-year data (P = .9999 and .9993, respectively). No significant differences were noted between the products. Conversion to the generic product was projected to save $90,000 annually.

Editor's Comment

Good practice dictates caution when switching products with a narrow therapeutic window. The authors of this study demonstrate how careful monitoring and data can be a powerful tool in overcoming negative impressions of generic products generated by anecdotal reports, allowing for cheaper, effective alternatives.

Abstract

From
Journal of the American Pharmaceutical Association
March/April 2001 (Volume 41, Number 2)

Performance of Community Pharmacy Drug Interaction Software

Hazlet TK, Lee TA, Hansten PD, et al.
J Am Pharm Assoc (Wash). 2001;41:200-204
Missed drug interactions by pharmacists and prescribers can have a significant negative impact on patient outcomes and can increase associated medical costs. Pharmacists often rely on computer software to identify potential drug interactions. This study was designed to assess the ability of community pharmacy computer programs to identify drug-drug interactions (DDIs).
The authors developed 6 patient profiles that required the entry of 24 unique prescriptions and included 37 DDI pairs. The investigators chose to benchmark 16 DDIs that were considered contemporary, well documented, and clinically important. One of 2 authors (TKH or TAL) entered the profiles into the computers of major outpatient chain and HMO pharmacies in the Seattle area. Any warnings or alerts that were generated as a result of the input were documented.
The sensitivity of the computer systems evaluated (clinically important DDIs identified by the software) ranged from 0.44 to 0.88. The specificity (ability of the software to ignore those interactions not deemed to be clinically relevant) ranged from 0.71 to 1.00. Most of the systems did not allow for drug-gender or drug-disease checking.

Editor's Comment

The explosion of new pharmaceutical entities as well as new information about drug-disease and drug-drug interactions has increased the pharmacist's reliance on computerized software to identify potential problems with treatment regimens. This study would suggest that these programs must continue to be viewed only as tools and not as definitive screens for potential drug therapy problems. Perhaps of even greater concern is the potential for hand-held drug information for prescribers to be expected to identify any potential problem prior to prescribing. Reliance on a system without incorporation of individual clinical expertise may result in unintended patient harm.
Abstract
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From
Pharmacotherapy
March 2001 (Volume 21, Number 3)

Comparison of Length of Hospital Stay for Patients With Known or Suspected Methicillin-Resistant Staphylococcus Species Infections Treated With Linezolid or Vancomycin: A Randomized, Multicenter Trial

Li Z, Willke RJ, Rittenhouse BE, et al.
Pharmacotherapy 2001;21:263-274
Treatment of methicillin-resistant Staphylococcus aureus (MRSA) has primarily been limited to vancomycin. Vancomycin, for this indication, is only available as an intravenous (IV) formulation. Linezolid, an oxazolidinone, is available as both an oral and IV product for the treatment of MRSA. This study evaluates the use of resources in comparing vancomycin therapy to treatment with linezolid.
Patients at least 13 years of age with known or suspected MRSA infection were eligible for enrollment in the study. Data were collected and analyzed from a total of 460 patients treated in hospitals in several countries. Vancomycin was administered as a 1-g dose every 12 hours. Linezolid was given as either 600 mg IV or orally every 12 hours.
Median length of stay for patients with complicated skin and soft-tissue infection (230 patients) treated with linezolid was 5 days shorter than for patients treated with vancomycin (P = .05). There was a statistically significant difference in mean and median durations of intravenous antibiotic treatment between linezolid and vancomycin (P < .001), with linezolid-treated patients receiving shorter courses. Discharges during the first week of treatment were more common in the linezolid-treated group.

Editor's Comment

Studies such as this one are useful for organizations attempting to define the total impact of a new drug on the overall costs of healthcare. Although not definitive, this study indicates that a newer, more expensive agent for the treatment of MRSA may actually decrease overall resource utilization and associated costs. It is often difficult for pharmacy administrators, though, to help the finance people of an institution to understand that the drug budget may actually have to go up in order for overall costs to come down.
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