Evaluating CPOE systems: Key comparative criteria you'll need to consider
March 1st 2002If your organization hasn't yet selected a computerized provider order entry system (CPOE), it will likely benefit from the checklist of features and functionality criteria presented by Richard Diefes, MS.
Read More
Expanded role for the P & T Committee: Gaining patient consent for off-label drug use
March 1st 2002What's your institution's policy for handling the following situation: A physician wishes to prescribe an FDA-approved drug for an off-label indication for which there is little literature support.
Read More
Automatic IV to PO conversion process provides greatest gains for hospital, patient
March 1st 2002Hartford Hospital, Hartford, CT-Although the economic advantages of IV to oral (PO) antibiotic conversion programs have been documented in numerous studies, most of these programs require physician contact to encourage the switch.
Read More
Assessing the impact of outcomes projects: Take your lead from the AHRQ approach (PDF)
March 1st 2002To retain resources or to justify allocation of additional resources, it's essential to demonstrate the value that outcomes projects bring to organizations. The Agency for Healthcare Research and Quality's project review process serves as a useful model for how to do so. This month's column explores the AHRQ process for following up and communicating the results of outcomes projects conducted at various practice settings.
Read More
Medications currently available to treat osteoporosis slow the rate of bone loss primarily by reducing bone resorption. The purported advantage of the anabolic agent teriparatide is that it actually promotes new bone growth. Clinical trials have shown the drug to be effective for vertebral fracture prevention in postmenopausal women at high risk. Additional evidence is accumulating to support teriparatide's use in other populations (including men) with osteoporosis. This injectable is likely to receive FDA approval in the second half of this year.
Read More
Review and assessment of pharmacologic management strategies for reflux esophagitis (PDF)
March 1st 2002Pharmacologic therapy is the second cornerstone of the medical management of reflux esophagitis. Because the merits of various drug classes for reflux esophagitis have been widely discussed, the focus of this article is on differing strategies for using these classes. The management strategies - and the rationale and evidence for promoting or rejecting them - are discussed for step-up therapy, empiric therapy, ste-down therapy, on-demand proton pump inhibitor use, combination therapies, and other considerations.
Read More
Success of a P & T policy for use of a second ACE inhibitor before switching to an ARB (PDF)
February 1st 2002VA Medical Center, Miami-ACE inhibitor therapy is recognized as the gold standard treatment for congestive heart failure (CHF) as well as diabetic nephropathy due to its effect on the morbidity and mortality associated with these conditions.
Read More
With its FDA approval in November, valdecoxib becomes the hird COX-2 inhibitor to gain US market clearance. This Focus article examines valdecoxib's pharmacologic, pharmacokinetic, and therapeutic aspects and considers its role in relation to other COX-2 inhibitors and traditional NSAIDs. Special attention is devoted to its comparative COX-1:COX-2 inhibitory ratio and an array of unpublished efficacy and safety trials.
Read More
Huge meta-analysis refines role of antiplatelet therapy in high-risk patients
February 1st 2002This 287-study meta-analysis aimed to address unanswered questions about antiplatelet therapy in patients at high risk for occlusive vascular events. It yielded several new findings or clarifications, including these: (1) Antiplatelets protect against vascular events in patients with unstable angina, intermittent claudication, and atrial fibrillation. (2) Antiplatelet therapy can be started promptly during acute ischemic stroke and continued long-term. (3) Daily aspirin doses of 75 to 150 mg seem to be as effective as higher doses for long-term treatment.
Read More
UTI scripts trend away from drug of choice
February 1st 2002Fluoroquinolones and nitrofurantoin have surpassed trimethoprim-sulfamethoxazole (TMP-SMZ) as the most frequently prescribed antibiotics for uncomplicated urinary tract infections (UTIs) in women, according to a new national analysis. This is despite well-established recommendations (from the Infectious Disease Society of America and others) that TMP-SMZ is the drug of choice for UTIs due to cost and concerns about antibiotic resistance.
Read More
Three-tier benefit cuts Rx costs without unintended consequences
February 1st 2002A three-tier pharmacy benefit can reduce prescription drug spending without increasing other medical resource use or fueling medication discontinuation rates. So concludes the fully published report of an analysis whose preliminary results were presented last year and reported by Formulary (2001;36:522). It is the first well-designed, controlled study to explore such consequences of three-tier benefits.
Read More