Evaluation of drug interactions in patients treated with antidepressants at a tertiary care cancer center.

OBJECTIVE: We evaluated potential drug interactions in patients treated with antidepressants at a tertiary care cancer center to determine if it affects resource utilization. METHODS: We identified a cohort of patients with continuous care at the study institution by tagging patients who received at least three prescriptions for antidepressants within a continuous 6-month period. Data collected included demographics, cancer type and comorbidities, resource utilization (hospital and emergency room visits), and potential major drug interactions. Descriptive statistics and logistic regression were utilized in the analysis. RESULTS: The study population, which included 297 patients, was 70% female and 71% Caucasian; the mean age was 53 years (SD, 12 years), with a mean follow-up period (duration of therapy) of 403 days. Overall, 145 (49%) of the patients had a drug combination that could result in a potential major drug interaction with antidepressants. There were 118 (40%) patients with a potential major drug interaction that could lead to serotonin syndrome symptoms and 59 (20%) patients with a potential major drug interaction with anticoagulants. Potential major drug interactions were associated with an increased number of hospital and ER visits (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.39-4.03). This finding was consistent for the two subanalysis groups as well, serotonin syndrome-inducing drugs (OR, 2.28; 95% CI, 1.33-3.92) and anticoagulants (OR, 3.66; 95% CI, 1.85-7.22). CONCLUSION: Potential drug interactions are frequent in patients receiving antidepressants in a tertiary care cancer center and are associated with an increase in resource utilization.

Impact of changes in reimbursement policies and institutional practice algorithm for utilization of erythropoietic-stimulating agents on treatment patterns and costs in anemic lymphoma patients.

PURPOSE: The objective of this study was to assess the impact of a new evidence-based institutional practice algorithm on the patterns and costs of treatment of chemotherapy-induced anemia (CIA) in lymphoma patients prescribed erythropoietic-stimulating agents (ESAs). METHODS: The study design was retrospective, with a historical control group. Patient demographic data, clinical data (including chemotherapy and hemoglobin values), and cost data were extracted from patient medical charts and institutional databases. Descriptive statistics, t tests, and chi-square analyses were conducted to evaluate the study objectives. RESULTS: The study population consisted of 154 patients, 90 patients in the pre-implementation group and 64 in the post-implementation group. Both groups had similar demographic and baseline clinical characteristics. After implementation, there was a significant decrease in the mean hemoglobin level at the time of subsequent ESA dosing from 9.59 to 8.98 g/dL (P < 0.0001). The proportion of patients who received an ESA at a hemoglobin level >10 g/dL decreased significantly from 66% to 17% (P < 0.0001). There was no significant difference in the mean hemoglobin level at week 4 of ESA therapy, which may indicate that patients were not clinically affected by the change in practice. There were also no significant differences in the number of transfusions administered associated with the treatment of CIA in the study population. CONCLUSIONS: The results of the study show an association between implementation of the new institutional practice algorithm for ESA usage in CIA and a change in ESA utilization patterns.

Evaluation of rational use of medications in the United States.

Rational medication use means taking medication appropriately for curing and relieving the symptoms of disease on the basis of evidence and sound judgment. We compare US policy experience on rational use of medications with the World Health Organization (WHO) list of interventions designed to promote such use. Current US performance and educational, managerial, and regulatory interventions to improve it are discussed. We conclude that, while most of the WHO guidelines for rational medication use are practiced in some form in one or more of the various US health care subsystems today, overall performance based on outcomes is not comparable with that of other industrialized countries. This is due to the absence of a national drug policy, the presence of a few strong stakeholders with committed policy preferences, and the altogether fragmented character of the US state and federal health systems. Practical suggestions are offered as to how the US could improve its overall less-than-optimal policies on rational medication use.