Implementation of pharmacist-managed anticoagulation clinic in a saudi arabian health center.

BACKGROUND: During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care. The Pharmacy Services Division (PSD) in collaboration with physician, nursing, and medical support enterprises at the Dhahran Health Center established the pharmacy-managed anticoagulation clinic (ACC). OBJECTIVE: To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Saudi Arabia and its impact on patient care. METHODS: The PSD in collaboration with medical staff successfully created a care delivery model utilizing clinical pharmacists' expertise to provide comprehensive anticoagulation management services at Saudi Aramco Medical Services Organization (SAMSO). Planning included analyzing existing practices, reviewing the relevant literature, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines. Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians. Data (2 years before and after clinic inception) for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the clinic on anticoagulation management, adverse events, and patient satisfaction. RESULTS: A total of 578 patients were enrolled in the ACC. The total percentage of international normalized ratio (INR) within the target range was 59% versus 48% when compared to the previous traditional practice. The number of INR tests per patient dropped by 19%. Minor and major adverse events occurred in 10% and 1.5% of patients, respectively. Overall, the patients were very satisfied with the new clinic compared to the previous practice. CONCLUSION: Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores.

Improvement in vancomycin utilization in adults in a Saudi Arabian Medical Center using the Hospital Infection Control Practices Advisory Committee guidelines and simple educational activity.

OBJECTIVE: To evaluate vancomycin utilization according to the adapted criteria of the Centers for Disease Control and Prevention (CDC) with a report of the effect of education program on the utilization. METHOD: We evaluated the utilization of vancomycin over a 3-month period pre- and post-intervention using educational activity. RESULTS: In the pre-intervention period, of the 74 adult patients vancomycin was prescribed for specific treatment in 66% (n=49), empirical therapy in 26% (n=19) and as a prophylaxis in 8% (n=6). Vancomycin utilization was considered appropriate based on the CDC recommendations in 48 (65%) patients. Forty-seven (64%) patients received an appropriate dose regimen based on weight, age and creatinine clearance. Only 31% (n=23) of patients had both peak and trough levels taken around the third dose. In the post-intervention period, vancomycin was used as specific therapy in 41% (n=14) and empirically in 59% (n=20). Compliance with guidelines for empirical use of vancomycin improved from 21% in the pre-intervention phase to 85% after the intervention (P=.0001). In addition, compliance with vancomycin use in specific therapy was 100% compared to 82%. Compliance rate with vancomycin trough level monitoring increased from 35% in the pre-intervention period to 67.7% in the post-intervention period (P=0.0002). CONCLUSION: In conclusion, in addition to the utilization of CDC based criteria for vancomycin, we had shown that patient's chart review by a clinical pharmacists with a feed back to the physicians when guidelines were not met coupled with and educational efforts are effective methods to decrease inappropriate vancomycin usage.

National Cholesterol Education Panel III performance in preventing myocardial infarction in young adults.

BACKGROUND: Only one published trial has directly evaluated the utility of the new National Cholesterol Education Program (NCEP) guidelines in young adults and that study population consisted of young Americans. We examined the utility of the latest NCEP Adult Treatment Panel III (ATP III) guidelines in a group of young Lebanese adults. METHODS: A group of 234 young adults admitted for myocardial infarction at a Lebanese teaching hospital over a 2-year period were evaluated retrospectively. The Framingham risk predictor model was used to calculate the 10-year risk for coronary events in all subjects. RESULTS: Two hundred young Lebanese adults with a mean age of 49.7+/-7.6 years were included in the analysis. The majority of the study population had a history of smoking (67%) and LDL cholesterol <130 mg/dL (70.5%) and were considered overweight and obese (80.5%). As a group, 80% did not meet the criteria to qualify for antilipemic pharmacotherapy prior to their presentation. CONCLUSION: The predictive model did not detect the majority of these patients. Clinicians should treat modifiable risk factors with the same intensity given to cholesterol even if the patient has a normal lipid profile.

Intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration.

Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, is used in the treatment of cancer. It was the first clinically available angiogenesis inhibitor in the U.S. Recently, bevacizumab has been used by ophthalmologists in the intravitreal treatment of choroidal neovascularization in age-related macular degeneration. Since all published trials were less than one year in duration, including follow up, no conclusion can be drawn about the long-term safety and efficacy of intravitreal bevacizumab. In open-label studies, however, intravitreal bevacizumab has yielded marked improvements in visual acuity and central retinal thickness. Compounding pharmacists who are validated in aseptic compounding can prepare intravitreal bevacizumab from the available preservative-free phosphate-buffered intravenous solution using strict aseptic technique.

Focus on topiramate in neuropathic pain.

Topiramate is a drug that has shown efficacy in the treatment of epilepsy. A survey of MEDLINE, EMBASE and the American Academy of Neurology Abstracts reveals there is now evidence that topiramate is also effective in the treatment of neuropathic pain. The dose that has been studied ranges from 25 mg to 800 mg with a suggested dose of 400 mg daily. However, further randomized, double blind studies are needed to confirm this new use of topiramate and explore the proper dose and mechanism of action. Topiramate is conspicuous amongst the antiepileptic drugs for being well tolerated and having fewer drug interactions. Thus, it might offer an advantage over such drugs.