Change in Prescribing Patterns of Intravenous Histamine2-Receptor Antagonists Results in Significant Cost Savings without Adversely Affecting Patient Care

Author:

Fudge Kathy A.1,Moore Keith A.2,Schneider Donald N.3,Sherrin Thomas P.3,Wellman Gregory S.4,Mcghan William F.5,Bootman J. Lyle6,Townsend Raymond J.7

Affiliation:

1. Riverside Methodist Hospitals, 3535 Olentangy River Rd., Columbus, OH 43214

2. Intensive Care Services and Pharmacokinetics

3. Pharmacy Services

4. Pharmacy Services, Riverside Methodist Hospitals.

5. Institute for Pharmaceutical Economics, Philadelphia College of Pharmacy and Science, Philadelphia, PA

6. College of Pharmacy, University of Arizona, Tucson, AZ 85721

7. Applied Healthcare Research, Glaxo Inc., Research Triangle Park, NC 27709.

Abstract

Objective The cooperative efforts and educational activities associated with a major histamine2-receptor antagonist (H2RA) formulary change and the clinical and financial results are described. Evaluation Process An extensive financial and clinical evaluation was conducted. Sources included primary literature, reference texts, institution-specific financial data, and reports of other hospitals’ experiences. Interventions Through cooperative efforts with key members of the medical staff, several interventions were adopted: maintain only one parenteral H2RA on the formulary; develop guidelines for H2RA use and stress ulcer prophylaxis; investigate a target drug-reminder system to promote oral H2RA use. Results Within a month after implementing the formulary change and educational process, prescribing of parenteral H2RAs changed from 80 percent ranitidine to 99 percent cimetidine. Monitoring of nonformulary ranitidine use revealed only three cases of possible or probable association of adverse central nervous system effects with cimetidine in an eight-month period. Elevations of theophylline, lidocaine, or phenytoin serum concentrations; or prothrombin time above the therapeutic range during warfarin therapy occurred in only 5 of 142 monitored patients who received concomitant therapy with an H2RA. No change in serum theophylline concentrations above the therapeutic range was noted in the hospital before and after the conversion. Savings have been estimated at $250 000 in the first year and $775 000 over four years, mostly from the conversion from intravenous ranitidine to intravenous cimetidine therapy. Conclusions Successful intervention can be accomplished by cooperation between the pharmacy and the medical staff to achieve cost savings without sacrificing the quality of care.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

Cited by 10 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?;World Journal of Gastrointestinal Pharmacology and Therapeutics;2011

2. Stability and compatibility of histamine H2-receptor antagonists in parenteral nutrition mixtures;Current Opinion in Clinical Nutrition & Metabolic Care;2007-05

3. Economic Evaluations of Clinical Pharmacy Services (ACCP);Encyclopedia of Clinical Pharmacy;2002-11

4. Overuse of acid-suppressive therapy in hospitalized patients1;The American Journal of Gastroenterology;2000-11

5. Consider potential for drug interactions during formulary review;American Journal of Health-System Pharmacy;2000-02-15

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