Drug Topics - April 14, 2008 - (Page HSE12)

12 HSE DRUG TOPICS APRIL 14, 2008 www.drugtopics.com > > > Professional Practice Reconciling meds in specialty patients poses more challenges Fred Gebhart H ow effective is medication reconcommon medical problems and medicaciliation in your institution? tions. Thorne noted two potential problems That’s a question that many for patients who are admitted with a rare pharmacists may not be able to answer. disease or who are taking unfamiliar mediBut answers are beginning to emerge at cations. One is a communication gap. The two institutions, Parkview Hospital in Fort person in charge of medication reconciliaWayne, Ind., and Children’s Healthcare tion may not recognize the disease or the of Atlanta (CHOA), Ga. Both institutions drug. The patient may not recognize the are studying medication reconciliation in unusual nature of the disease or the drugs Continuity of care specialty populations. needed to treat it. is critical, says Parkview pharmacy resident Alicia Rochelle Schmidt. “If you don’t recognize a drug the patient Thorne is evaluating an internal study of is on at admission, or don’t recognize the medication reconciliation for multiple sclerosis (MS) disease and know to ask about specific drugs, it’s easy patients at admission and again at discharge. The ret- to forget to check whether it needs to be continued on rospective chart review evaluated 34 MS patients who an inpatient basis,” Thorne said. were admitted during the first half of 2007. On the The other problem is structural. Drugs that tarlow end, between 29% and 68% of patients who were get rare diseases such as MS are frequently not on admitted with MS-related medications continued inpatient formularies. Writing nonformulary orders, those meds during their inpatient stay. Anti-fatigue especially for expensive agents such as any of the agents had the lowest continuation rate and muscle interferons, is a barrier to care. “Products that are on relaxants the highest rate. Disease-altering agents had formulary are much more likely to be continued,” the second-best results with 65% continuation. Thorne said. “It’s not that we want to discontinue At the high end, between 82% and 90% of patients therapy the patient is on, it’s that we don’t have the had discharge orders to continue the MS medications agent available.” they had been taking at admission. Disease-altering The problems are different for adolescent transagents fell at the low end of the range and muscle plant patients. There can be a physical transition relaxants at the high end. Anti-fatigue agents fell in of care from pediatric to adult providers, as from the middle at 86% with continuation orders. “I don’t CHOA across the street to Emory University Hosknow if 86% is good or bad,” Thorne said. “The data pital, Schmidt said. But other transitions are just as just are not out there to quantify rates overall. But at important. least we know what our institution was doing in this Many children lose insurance coverage when they small population.” turn 18 and drop off their parents’ policies, she noted. In Atlanta, CHOA is taking an interventional That creates financial barriers to continuing care approach. Children’s transplant services pharmacy and increases the risk of graft loss. The social and specialist Rochelle Schmidt is running the numbers emotional changes of adolescence also translate into on a pilot clinic designed to smooth the transition increased risk for graft loss. from pediatric care to adult care for kidney transplant Adolescents tend to be less adherent to drug regipatients. mens, lab work, and clinic visits. They may feel peer “What we know is that adolescents have the worst pressure against prescription drug regimens as well as five-year graft survival rate, similar to patients over perceived side effects such as acne and weight gain. the age of 65,” Schmidt said. “As they move from pe- “The transition from pediatric care to the adult setdiatric providers to adult providers, there seems to be ting has been studied in diabetes and cystic fibrosis, a gap in care.” Results from the first six months of the but nobody knows what really happens with transclinic should be released later this year, Schmidt said. plant patients,” Schmidt said. “It’s no different from Both pharmacists noted that medication recon- the transition from inpatient to outpatient care; it just ciliation is trickier when it comes to patients with less takes a few years longer.” DT http://www.drugtopics.com

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Drug Topics - March 14, 2008 Contents Latebreakers Letters: Students Need Grounding in Chemistry Pharmacy Directors Wary of Heparin Shortages Some E-prescribing Standards are Ready to Go, Others are Not News Briefs Nanotechnology: Big Stakes in a Small World Pay for Performance is Coming to Pharmacy Patient Safety Organizations Still Very Much in Planning Stage Reconciling Medications in Specialty Patients Poses More Challenges Pharmacy Outsourcing Still Much in Use by Hospitals Studied Extensively, New Drug-Eluting Stent Said to be Very Safe Prevention is Key in Treating C. Difficile Infections E-prescribing Grows in Massachusetts, but Other States Lag Behind Active Metabolite Gives New Life to Antidepressant NSAIDS not Recommended for Long-term Use in Osteoarthritis This Time R.Ph.s and States Are Ready for Tamper-Resistant Rx Pads Cardinal Caught Between DEA and Pharmacies over Diversion Control Medicating Kids: Still More Questions than Answers Schnucks Pharmacy: Drug Topics' Chain of the Year Panel Will Ask for a System for R.Ph. Practice Across State Lines FDA Safety Page: How to use Fentora Safely The Shining OTC/HBC Stars of 2007 Take a Look at These OTCs for Eye Health Technology Update: Google Offers a Sneak Peak at its Electronic Records Initiative Recent Advancements in HIV/AIDS Treatment New Products Advertisers Index Classified Viewpoint: Are State Boards of Pharmacy Abusing Their Power?

Drug Topics - April 14, 2008

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