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Biomedical subjects

M A Chisholm

Publications and source records attributed to M A Chisholm.

18 recordsLinked to original sources
PubMed2001

Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications.

BACKGROUND: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-transplant care. This randomized, controlled trial evaluates the impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive agents. METHODS: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the intervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histories and review of patients' medications with an emphasis on optimizing medication therapy to achieve desired outcomes and minimizing adverse medication events. The clinical pharmacist also provided recommendations to the nephrologists with the goal of achieving desired outcomes. To promote medication compliance by using compliance enhancement strategies, the clinical pharmacist counseled patients concerning their medication therapy and instructed them how to properly take their medications. Patients in the control group received the same routine clinic services as the intervention group except that they did not have any clinical pharmacist interaction. Compliance rate (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month, and the mean time patients were compliant were compared between groups. Whether there was a difference in the frequency of patients achieving 'target' immunosuppressive levels in the control and study groups was evaluated. RESULTS: The mean CR for patients who had clinical pharmacist intervention (n=12) was statistically higher than the control group's (n=12) mean CR (p<0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients in the control group (p<0.05). Additionally, patients who had clinical pharmacy services had a greater achievement of 'target' levels than patients who did not receive these services (p<0.05). CONCLUSIONS: Patients who received clinical pharmacy services with traditional patient care services had better compliance with immunosuppressants than patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharmacist as part of the care for post-transplant patients is beneficial for enhancing medication compliance.

Chi-Square Distribution↗
PubMed2000

Renal transplant patient compliance with free immunosuppressive medications.

BACKGROUND: Noncompliance with immunosuppressive medications after renal transplantation is believed to be a major cause of allograft rejection and graft loss, with the impressive costs of these agents considered a significant reason for noncompliance. Our purpose was to determine the compliance rates of renal transplant patients who received their immunosuppressant therapy free of charge and evaluate their patterns of compliance. METHODS: All patients who received a renal transplant and received their immunosuppressant medications at our institution for their first year posttransplant were included in the study. Compliance rate was calculated and serum immunosuppressant concentrations were obtained to validate compliance assessments. RESULTS: Eighteen patients were included in the study. Approximately 48% of noncompliant patients were found to have subtarget drug concentrations, although only 14% of compliant patients had subtarget levels (chi2=12.9, P<0.001). At 5 months posttransplant, 95% of the patients remained compliant; however, by 12 months posttransplant, only 48% of the patients remained compliant. The mean time to the first noncompliant month was 9.8 months (95% confidence intervals=8.60-11.0). CONCLUSIONS: Patients who received their immunosuppressants free of charge were generally compliant within their first year of transplantation, however, compliance tended to decrease over time. This suggests that drug cost alone does not explain noncompliant behavior. Intensive efforts to increase medication compliance before month 8 posttransplantation should be implemented.

Adult↗
PubMed2000

Medication assistance programs for uninsured and indigent patients.

Pharmaceutical company-sponsored medication assistance programs and the pharmacist's role in obtaining medications for indigent patients are discussed. Information about enrolling in medication assistance programs can be obtained through a variety of sources, including the Internet. Although some eligibility criteria may be common to many programs, each company operates independently, and the eligibility criteria vary, individuals involved in the administration of medication assistance programs should strive to ensure that correct information is reported. Pharmacists can play an important role in acquiring medications for patients by reviewing patient information, recommending patients for enrollment, and serving as a liaison between the patient or health care provider and the program administrator. Many pharmaceutical companies have programs that provide prescription medications to indigent or uninsured patients. Pharmacists can serve as a liaison between these programs and the patient or the health care provider.

Drug Industry↗
PubMed2000

Assistance programs available for medications commonly used in transplant patients.

Pharmaceutical manufacturers have programs available to supply medications to indigent patients at little or no cost. Enrolling needy patients into these programs should increase patient compliance to medications, minimize patient and institution financial burdens, and decrease adverse events associated with medication noncompliance. However, access to assistance programs by patients in need is limited if physicians and other health care providers are unaware of the existence of such programs or not informed of each program's enrollment process. The literature is void of a manuscript describing assistance programs available for commonly prescribed medications used in transplant patients. This article offers a concise summary of medication assistance programs available through the pharmaceutical industry to assist in the procurement of medications that are commonly prescribed for the transplant population, including immunosuppressants, antibacterials, gastrointestinal, cardiovascular, and hypoglycemic agents. This article should be used by health care professionals as a guide to the availability and requirements of medication assistance programs.

Anti-Bacterial Agents↗
PubMed2000

Cost-benefit analysis of a clinical pharmacist-managed medication assistance program in a renal transplant clinic.

UNLABELLED: Medicare pays for 80% of the cost of immunosuppressant agents needed within the first 3 years of solid organ transplantation; however, many patients cannot afford the remaining 20%. Furthermore, many patients who are beyond 3 years post-transplantation and have prescription coverage cannot afford the co-payment for these medications. Other patients may not be able to afford their medications due to limited or no insurance coverage. The Medical College of Georgia (MCG) has been giving immunosuppressant medications to renal transplant patients if they cannot afford to pay for them. To assist MCG with drug cost for medications and maintain quality care for renal transplant patients, a clinical pharmacist-managed medication assistance program was implemented to procure immunosuppressants from pharmaceutical manufacturers. METHODS: All patients enrolled in medication assistance programs from 1 January 1998 through 31 December 1998 were included in this analysis. Medication acquisition costs with and without Medicare reimbursement and the cost of implementing the clinical pharmacist-managed medication assistance program were used to determine the value of implementing this service. RESULTS: Sixty-one patients were enrolled in manufacturers' assistance programs and a net cost avoidance of $124,793 was realized for the year of the program (benefit-to-cost ratio of 7.5:1). Assuming that the hospital collected the maximum amount allowed for patients receiving Medicare benefits, a cost avoidance of $69,233 was calculated (benefit-to-cost ratio of 4.16:1). CONCLUSIONS: A clinical pharmacist-managed medication assistance program in a renal transplant clinic produced substantial cost savings over this 1-year study period. For each dollar spent in pharmacist's time, a minimum of $4 was returned to the institution.

Cost-Benefit Analysis↗
PubMed2000

Deep venous thrombosis prophylaxis in trauma: cost analysis.

Deep vein thrombosis and pulmonary embolism are major risks in patients experiencing major trauma. Currently, the American College of Chest Physicians recommends low molecular weight heparin as prophylaxis in trauma patients with identifiable risk factors in the absence of contraindications. Enoxaparin is the only low molecular weight heparin available in the US that has been evaluated to date in this indication. The purpose of this study was to perform incremental cost-effectiveness ratio calculations for enoxaparin versus no prophylaxis as thromboembolic prophylaxis in trauma patients. These calculations demonstrate that a cost of $279.43 would be incurred for each thromboembolic event avoided if enoxaparin 30 mg every 12 h were routinely used as prophylaxis in this population, compared with no prophylaxis. Sensitivity analyses demonstrate that if the incidence of proximal vein thrombosis in patients prophylaxed with enoxaparin approached 1.8%, if the actual rate of these thrombi exceeded 19.4% in untreated patients, or if the cost of the drug was decreased to $15.25 per dose, a cost saving would be experienced in routine prophylaxis with this agent.

Contraindications↗
PubMed2000

Cost effectiveness of deep venous thrombosis prophylaxis after hip fracture.

Patients undergoing hip fracture repair are at significant risk for deep vein thrombosis and pulmonary embolism in the postoperative period without appropriate prophylaxis. Agents available in the United States that have undergone clinical trials as pharmacoprophylaxis for this indication include warfarin, dalteparin, and danaparoid. Safety and efficacy data from these trials were used to determine the most cost-effective agent for routine deep vein thrombosis prophylaxis in patients with hip fractures. Incremental cost-effectiveness ratio calculations demonstrate that warfarin dosed to an international normalized ratio of 2-2.7 is currently the most cost-effective agent in these patients.

Anticoagulants↗
PubMed1996

Acute management of cancer-related hypercalcemia.

OBJECTIVE: To review the pathogenesis and pharmacologic treatment of acute hypercalcemia associated with malignancy. DATA SOURCES: A MEDLINE search (1966 to 1995) of the English-language literature pertaining to acute hypercalcemia was performed. Additional literature was obtained from reference lists of articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles discussing the etiology and medical management of cancer-related acute hypercalcemia were considered in this review. Clinical trials reporting efficacy and safety of antihypercalcemic agents were also included. Information selected in the review was based on the discretion of the authors. DATA SYNTHESIS: Hypercalcemia is a life-threatening disorder associated with malignancy. It occurs in approximately 10-20% of patients with cancer. A variety of medications have been used in the management of hypercalcemia including bisphosphonates, calcitonin, furosemide, gallium nitrate, glucocorticoids, NaCl 0.9%, and plicamycin. Each of these agents has been reviewed with consideration of pharmacologic mechanism of action, evaluation of clinical trials, recommended dosages, efficacy, safety, cost, and role in treating cancer-related acute hypercalcemia. CONCLUSIONS: Immediate management of cancer-related acute hypercalcemia to prevent death and provide symptomatic relief is warranted. Severity determined by symptoms, calcium concentrations, and the overall status of the patient are important considerations in selecting appropriate therapy. Although the specific role of individual agents may vary, hydration remains the cornerstone of therapy. NaCl 0.9%, calcitonin, and pamidronate disodium have established roles as dominant first-line agents for the management of acute hypercalcemia associated with malignancy.

Calcitonin↗
PubMed1995

Implementation of pharmaceutical care in acute medical cardiovascular patients.

All inpatients who were admitted to one designated cardiologist at a private community hospital were followed by a pharmacist. The pharmacist prospectively evaluated the patients' medications in order to identify, resolve, and prevent any medication related problems. Recommendations concerning these medication related problems were made to the physician involved. In addition, the pharmacist documented medication information questions, medication dosing consultations, and patient medication counseling consults. Ninety-seven percent of the recommendations were accepted by the prescriber. The most common categories of recommendations were for drugs belonging to cardiovascular (40.3%) and anti-infective (18.4%) classes. Improper medication selection (19.6%), untreated indication (17.4%), overdosage (16.3%), and medication given without an indication (13%) were the most common medication related problems and accounted for over two-thirds of the total accepted recommendations. Sixty-six percent of the recommendations were considered significant and 4% were considered extremely significant. Based on the pharmacist's interventions, an annual patient medication charge savings of $17,576.00 was estimated.

Acute Disease↗
PubMedDate not supplied

Venous thrombosis after acute spinal cord injury: cost analysis of prophylaxis guidelines.

OBJECTIVE: Venous thrombosis and pulmonary embolisms are major complications associated with acute spinal cord injury. The purpose of this study was to perform a cost analysis on the two pharmacoprophylaxis regimens suggested for deep vein thrombosis prophylaxis in this population. METHODS: Efficacy and safety data were obtained from the literature. RESULTS: Results of the cost analysis demonstrates that adjusted dose unfractionated heparin produces a cost savings over enoxaparin at 30 mg every 12 hr. CONCLUSION: Further studies are needed to determine the most cost-effective therapy for preventing deep vein thrombi in this population.

Anticoagulants↗
PubMedDate not supplied

Isolating the cost of osteoporosis-related fracture for postmenopausal women. A population-based study.

BACKGROUND: Osteoporosis is a condition that will pose an increasing burden on health systems as populations age. OBJECTIVE: The objective of this study was to estimate the net 'per case' direct medical cost of fracture of indigent women age 50 years or greater and describe the cost of fracture for Medicaid and Medicare payers by inpatient hospital, physician, long-term care, prescription and miscellaneous expenditures. METHODS: This study utilized a quasi-experimental retrospective interrupted time series design to isolate the economic impact of fracture. Administrative claims data for a continuous period of 24 months (12 months prior to fracture and 12 months after fracture) describing the Medicaid and Medicare expenditures for a cohort of women suffering from femur or other fracture in 1993 was abstracted and analyzed. ICD-9CM and CPT-4 codes were used to identify incident cases of fracture. Interrupted time series regression models were estimated using monthly expenditures. RESULTS: A total of 765 Medicaid eligible women 50 years of age or greater experienced a fracture in the base year and met inclusion criteria. Of these, 226 experienced a femur fracture. The time series models detected significant increases in expenditures the month of fracture, however, total Medicaid expenditures returned to baseline trend charge in 7 and 5 months for femur and nonfemur fracture, respectively. Increases in long-term care expenditures persisted throughout the time series, but were offset by reductions in other categories of service. CONCLUSION: The net per case costs of femur and nonfemur fracture are about USD 3,300 and USD 1,300, respectively. The impact of fracture on Medicaid expenditures is temporary as costs rise sharply and return to baseline trend charges within a 12-month period.

Aged↗