ABSTRACT
Purpose: The purpose of the study is to evaluate the impact of heart failure medication education on 30-day all-cause readmission rates and patient-reported satisfaction scores. Methods: This single-center pilot study was conducted at a 396-bed tertiary-care hospital in the Midwest from September 2017 to December 2018. For research purposes, patients were divided into 2 groups. The control group was looked at retrospectively and included patients who received education by the nurse educator. The intervention group was reviewed proactively and included patients who received education by a pharmacy student. The purpose of the study was to compare readmission rates among patients who received medication education from pharmacy students with those who received the same education by the heart failure nurse educator. The primary outcome was 30-day all-cause readmission rate among those with a diagnosis of heart failure. The secondary endpoints included patient satisfaction scores by phone survey. The patient satisfaction phone survey was conducted by a single pharmacist 1 week after patient education was provided. Results: For the primary endpoint, there were 222 patients in the treatment group compared with the control group of 941 patients. The treatment group resulted in 30 (13.5%) of the 222 patients being readmitted within 30 days compared with the control group where 186 (19.6%) of the 941 were readmitted (P = .0395). The risk reduction in odds ratio and relative risk of readmission was 0.63 (confidence interval [CI] = 0.42-0.96) for the treatment group and 0.68 (CI = 0.48-0.98) for the control group. For the secondary endpoint, 56 patients were called 1 week after discharge, and there was no significant difference in overall patient satisfaction between groups. Conclusion: This study demonstrated that heart failure medication education provided by the pharmacist or pharmacy student resulted in improved patient outcomes and ultimately a reduction in 30-day all-cause readmission rates.
ABSTRACT
OBJECTIVE: To review the clinical pharmacology, efficacy, and safety of abiraterone acetate for metastatic castrate-resistant prostate cancer (mCRPC) and evaluate the drug for health-system formulary inclusion. DATA SOURCES: Literature was identified through a search of MEDLINE (1977-February 2012) and International Pharmaceutical Abstracts (1977-February 2012) using the search term abiraterone. References of identified articles were reviewed. STUDY SELECTION AND DATA EXTRACTION: All clinical trials published in English were evaluated. Studies conducted in the setting of mCRPC were included in the literature review. DATA SYNTHESIS: Despite benefits from androgen deprivation for the treatment of prostate cancer, most patients experience disease progression within 12-48 months, a phase described as castrate resistant. Abiraterone is the only Food and Drug Administration-approved hormonal treatment option for mCRPC in men who have received docetaxel and is recommended as a second-line agent for this indication in the National Comprehensive Cancer Network prostate cancer guidelines. One Phase 3 study, 2 Phase 2 studies, and 2 Phase 1 studies conducted in the setting of second-line treatment of mCRPC were identified. Treatment with abiraterone was associated with at least a 50% reduction in prostate-specific antigen (PSA) in 38-51% of patients; PSA progression ranged from 5.6-10.2 months. The only study assessing mortality outcomes found a 13% absolute reduction in mortality (ie, 42% vs 55%; HR 0.65; 95% CI 0.54 to 0.77), relative to placebo, over a median 12.8 months of follow-up. Abiraterone has been compared only to placebo, not to existing treatment options. CONCLUSIONS: Abiraterone provides a moderate improvement in disease progression and mortality in a patient population with limited treatment options. It is recommended to add this medication to outpatient formularies restricted to second-line treatment of mCRPC.
