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Biomedical subjects

J D Grabenstein

Publications and source records attributed to J D Grabenstein.

At least 55 records · Page 3Linked to original sources
PubMed1990

Pharmacoepidemiologic program for identifying patients in need of vaccination.

The feasibility of identifying candidates for vaccination by analyzing patients' use of prescribed drugs as recorded in a computerized database was investigated. Pharmacists at a 45-bed hospital serving U.S. Armed Forces in Germany developed a list of drugs used to treat patients with diagnoses that warrant influenza or pneumococcal pneumonia vaccination. In December 1988 and April 1989, the facility's pharmacy database was searched for patients who had received the infection-risk-indicating drugs during September 1, 1988-March 30, 1989. Medical records of patients identified were screened to verify the indications for vaccination. Patients at risk were sent letters and prescriptions written by a pharmacist to inform and remind them of their need for vaccination. Of 109 patients for whom records were screened, 80 (73.4%) had valid indications for immunization. Of these 80 patients, 48 (60%) accepted the invitation to be immunized. The 80 patients in need of vaccination received 151 individual prescriptions; 77 doses (51%) were administered to 48 patients. Screening by pulmonary, cardiovascular, and hypoglycemic drug use identified the largest numbers of patients in need of vaccination, as did age over 64 years. Patients with more than one risk factor for infection were significantly more likely to accept vaccination than patients with only one risk factor. Pharmacoepidemiologic programs can help pharmacists to fulfill their role as advocates of immunization.

Drug Prescriptions↗
PubMed1990

Drug interactions involving immunologic agents. Part I. Vaccine-vaccine, vaccine-immunoglobulin, and vaccine-drug interactions.

Information about immunologic drug interactions is needed by pharmacists to make rational drug-use decisions. Previously, reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents were widely dispersed. In this two-part review article, over 50 individual and categorical interactions are described, as are dozens of vaccine-vaccine and vaccine-immunoglobulin, and vaccine-drug interactions are reviewed in this first part. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and to further assess known interactions.

Drug Interactions↗
PubMed1989

Incidence of anaphylactic self-treatment in an outpatient population.

Insect-allergic and food-allergic patients with a history of previous anaphylactic reactions were retrospectively and prospectively evaluated for incidence of self-administration of epinephrine or antihistamines. Participants were prescribed either Ana-KitR or Epi-PenR dosage forms. In 33 patients, 82 incidents were noted during 1,252 patient-months, an average of 0.78 incidents per patient-year (PPY). A mean of 0.38 epinephrine uses PPY was recorded, ranging from 0 to 2.82 doses PPY. Antihistamine uses averaged 0.69 PPY, ranging from 0 to 4.47 doses PPY. Antihistamines alone quelled reactions in 13 of 17 incidents involving Ana-Kits. Food-allergic patients were more likely to self-medicate, with 1.93 anti-allergic drug uses PPY, compared with 0.49 uses PPY for insect-allergic patients. Six of 22 insect-related epinephrine uses occurred during winter months. No statistically significant difference was noted between drug administration rates determined retrospectively and prospectively.

Anaphylaxis↗
PubMed1986

Comprehensive immunization delivery in conjunction with influenza vaccination.

All patients and employees presenting for influenza A and B vaccination were studied for the need for other immunizations or tests, based on criteria of the Immunization Practices Advisory Committee. More than 72% of patients and employees needed at least one other vaccine or test. During a 4 1/2-month period, 1,353 doses of influenza virus vaccine, bivalent, types A and B, were prescribed. Health care providers ordered doses of diphtheria and tetanus toxoids (adult) for 36.8% of these recipients, pneumococcal vaccine, polyvalent 23, for 42.1%, and a tuberculin skin test for 36.3%. Determinations of hepatitis B titers or hepatitis B vaccine doses were ordered for 140 individuals. Patients older than 60 years needed additional immunizations with greater frequency. Rates of delayed adverse reactions (35.9%) and subsequent self-medication (11.7%) were recorded. The systemic adverse reaction rate was 17.3%. Annual influenza vaccination programs are valuable public health opportunities to determine immunizations needed by patients who might not otherwise receive a comprehensive, individualized review of the status of their immunization protection.

Adolescent↗
PubMed1985

A comprehensive allergen extract monograph with advice for the patient.

Interest in increased patient education regarding medications they receive is gathering momentum. An historical overview is provided as well as summaries of available patient information resources. To date little such information has been available for patients receiving immunotherapy with allergen extracts. A comprehensive draft monograph driven from multiple sources for the various products available is proposed, as well as suggested advice for patients. Comments and suggestions for revision are solicited, prior to proposed inclusion in a national patient information publication.

Allergens↗
PubMed1985

Operation of an allergen-extract pharmacy.

The quality control (QC) and quality assurance (QA) systems for a military allergen-extract pharmacy are described. The United States Army Allergen Extract Laboratory (USAAEL) provides diagnostic and therapeutic allergen-extract materials to military personnel throughout the world. More than 40,000 individualized prescriptions are compounded annually. The staff is composed of one pharmacist, 16 medical technicians, and four clerical, two inventory, and three supervisory personnel. Each prescription takes about one man-hour to prepare. The technicians are trained in aseptic technique, allergen-extract compounding, and the diagnosis and treatment of allergies during an eight-week program. Following a physician-allergist's evaluation of a patient, a prescription is written with a formula itemizing the specific allergen components, their relative concentrations, and a treatment schedule. Patient profile cards are kept on every patient. A complete record of patient, prescriber, demographic data, allergen formula, treatment schedule, lots, and initials of personnel responsible at each step allow a thorough assessment for QC and QA. The identity and volume of each allergen in every prescription are checked twice. A multitiered QC system is used to identify problems and errors. A QA and QC assessment was conducted on more than 18,000 prescriptions received during a six-month period. More than 99% of all known errors were discovered before the prescriptions were dispensed. Allergen-extract prescriptions must be accurate, precise, and reproducible to be effective and to avoid adverse reactions. Pharmacists can play a vital role in ensuring the optimal quality of diagnostic and therapeutic allergen extracts.

Allergens↗
PubMedDate not supplied

Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker.

The US Department of Defense recently assembled electronic records of outpatient prescriptions dispensed through the Uniformed Services Prescription Database Project (USPDP) going back to 1990. The objectives of this portion of a larger study were: (1) to examine longitudinally the patterns of antihypertensive drug use during the first year of therapy in patients whose initial therapy was with an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker (CCB); (2) to determine continuous and noncontinuous users of antihypertensive drugs; and (3) to estimate the direct medication costs for each pattern of medication use. Filtering criteria for patient and prescription identification were developed, because the USPDP contains no records of confirmatory diagnoses of hypertension. Once data filters were implemented, information for 771 patients was analyzed. An ACE inhibitor was the initial therapy for 328 patients, accounting for 1935 antihypertensive medication prescription fills, and a CCB was the initial therapy for 443 patients, accounting for 2459 fills (including refills). Slightly more than half of the patients (n = 401, 52.0%) were classified as continuous users (> or = 80% medication-possession ratio [supply of medication in days divided by the number of days in the 12-month study period]). In the first year, 177 of these continuous users (44.1%) had no change in therapy in the first year, 49 (12.2%) had an increase in dose, 8 (2.0%) had a decrease in dose, 15 (3.7%) had a change to a different therapeutic class of antihypertensive medication, 14 (3.5%) were changed to a different medication in the same therapeutic class, 20 (5.0%) had a new medication added to the regimen, and 118 (29.4%) had complex regimens involving more than one change. For continuous users, the mean medication supply in days was 354.6, and the average time before a medication change was 152.1 days for those continuous users who had one change in therapy. The overall average wholesale price (AWP) and average manufacturer price (AMP) for continuous users during 1 year of therapy were $471.31 and $378.51, respectively. For those patients whose therapy was changed to an ACE inhibitor/CCB combination and who were continuous users, the average AWP was $598.47 per year ($492.05 AMP). Once the change from monotherapy to an ACE inhibitor/CCB combination occurred in continuous users, AWP costs per member per month increased by approximately $22.00 ($18.00 AMP). Over half of the patients whose initial therapy was an ACE inhibitor or CCB had at least one change in their first year of therapy. Research into the reasons for these changes and their outcomes is needed.

Angiotensin-Converting Enzyme Inhibitors↗