Pharmacy practice management quarterly
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Pharm Pract Manag Q · Apr 1999
Development and implementation of guidelines for management of sedation and agitation in critically ill patients.
The article describes the development, implementation, and success of guidelines for pharmacological management of sedation and agitation in critically ill patients in a community hospital. Guidelines were developed with careful review of published literature and in cooperation with thought leaders in the institution. ⋯ A prospective pharmacist intervention program was initiated for further enforcement of the guidelines. Implementation of these guidelines has resulted in a significant reduction in the cost of sedation and agitation (annual cost savings, > $40,000 per year).
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Pharm Pract Manag Q · Apr 1999
Comparative StudyCost-effectiveness analysis of oral ondansetron and prochlorperazine for preventing nausea and vomiting after moderately emetogenic chemotherapy.
The article reports a study comparing the cost-effectiveness of ondansetron tablets and prochlorperazine capsules in preventing nausea and vomiting after moderately emetogenic chemotherapy in an outpatient setting. A decision analysis model was constructed to compare the cost-effectiveness of the two antiemetics from the perspective of third party health care payers. Probability estimates of the model were derived from a reanalysis of data obtained from a clinical trial directly comparing the two antiemetics. ⋯ Cost-effectiveness ratios for ondansetron and prochlorperazine were $261 and $268 per effectively treated patient, respectively. A series of sensitivity analyses were performed to identify the limits of generalizability of study results. Despite the initial price differential between the two antiemetics, ondansetron was more cost effective than prochlorperazine when the duration of therapy was shorter than 3 days, the total cost of rescue therapy per patient was more than $71, the treatment cost of adverse events was less than $24, the complete relief rate for ondansetron was greater than 58.9 percent, and the complete relief rate for prochlorperazine was less than 26.5 percent.
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As health care costs continue to escalate, the assessment and management of medical technologies have become vitally important to health care providers. Evaluation and comparison of the safety, effectiveness, efficiency, cost, and clinical outcomes of new and existing technologies provide the critical information necessary to make appropriate clinical resource decisions in an increasingly cost-conscious environment. Technologies to be assessed include pharmaceuticals, devices, medical and surgical procedures, and health care delivery systems. Clinical trial results, literature reviews, expert opinions, and group consensus are used in preparing technology use decisions, which often include the preparation of background information, specific recommendations, use guidelines, and reimbursement analyses.
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Pharm Pract Manag Q · Jul 1996
Selecting antibiotics based on pharmacokinetic and pharmacodynamic principles.
Key pharmacokinetic and pharmacodynamic parameters influencing antimicrobial selection include the area under the curve (AUC) and minimum inhibitory concentration (MIC). These concepts can be integrated to describe the unique triangular relationship between the antibiotic, infecting organism, and patient. Antibiotic pharmacodynamics have been described as the ratio of AUC/MIC, maximum concentration to MIC, and time above MIC. ⋯ For example, aminoglycosides and fluoroquinolones have concentration-dependent killing while beta-lactams are concentration-dependent. This killing is also reflected in the post-antibiotic effect (PAE) that describes the prolonged activity even when the antibiotic levels are undetectable. These principles allow antibiotic classes to be selected and dosed via new strategies such as once daily aminoglycosides and continuous infusion beta-lactams.
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Pharm Pract Manag Q · Jul 1996
Designing drug-usage evaluation to meet Joint Commission requirements.
Strategies for influencing prescribing practices utilizing the drug-usage evaluation (DUE) process are described. Our DUE program has evolved into a collaborative program that provides significant pharmacy involvement while maintaining medical staff responsibility, as outlined by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). A multidisciplinary approach is utilized to identify prescribing problems, develop prescribing criteria, and provide educational initiatives. ⋯ Physician performance compliance is incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics Subcommittee, with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs, while meeting Joint Commission standards.