ABSTRACT
BACKGROUND: Diabetes with related complications is a common disease state seen in primary care and available therapies have increased exponentially. It is difficult for a busy primary clinician to know and utilize these options efficiently. OBJECTIVE: The objective was to determine whether creating a diabetes medication poster that included costs, drug classification, adverse effects, and clinical outcomes/contraindications/cautions for use in an internal medicine/medicine-pediatric clinic improves resident and faculty knowledge, comfort, and awareness of those medications. METHODS: This quality improvement prospective study was designed to evaluate the utility of a diabetes medication poster in a medicine/medicine-pediatric clinic over a 2-month period. A pre and post survey was electronically sent to all residents and faculty to assess their level of confidence and knowledge of diabetes medication treatment before and after the poster was distributed. This study was classified as exempt by the Institutional Review Board. RESULTS: There were 40 physicians that responded to the pre survey and 31 to the post survey. Both surveys revealed >90% agreed or strongly agreed that the poster would decrease risk of adverse reactions, help control cost, and increase confidence to providers about diabetic medications. The knowledge score increased pre vs post survey (P = .0398). CONCLUSION: There are a myriad of tools that can be utilized to help navigate complex diseases. Posters have rarely been evaluated. Physicians viewed the diabetes medication poster as favorable to help decrease adverse effects and cost while increasing knowledge. Areas where visual aids could be effective without overwhelming the providers should be explored.
ABSTRACT
PURPOSE: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers) continue to be over utilized for stress ulcer prophylaxis (SUP). Our study aims to evaluate the effectiveness and feasibility of a pharmacist-driven termination protocol in a community teaching hospital to limit the inappropriate use of acid-suppressive medications in the non-intensive care unit (ICU) setting. METHODS: Patient charts were evaluated for the appropriate use of PPIs or H2 blockers. A centralized pharmacist contacted healthcare providers for medication discontinuation if the acid suppressant use was deemed inappropriate. The primary outcome of the study was the number of patients who had acid-suppressive medication discontinued after the implementation of the pharmacist-driven termination protocol. RESULTS: Acid-suppressive medication was inappropriately prescribed for nine patients. It was discontinued for eight of those patients based on the pharmacist-driven termination protocol; this was a statistically significant decrease (P < 0.001). The pharmacist spent, on average, less than one minute on each patient's chart. CONCLUSION: Our study revealed that a pharmacist-driven termination protocol resulted in a 6% overall reduction rate in inappropriately used acid-suppressive medications, with little impact on pharmacist workflow. Implementing such a termination protocol could help to decrease the inappropriate use of acid-suppressive medications in an inpatient hospital service.