Pharmacy & Therapeutics - March 2008 - (Page 160) Compliance and Self-Monitoring of Blood Glucose Table 2 Results of Blood Glucose Test Strip Reviews in 100 Patients in the VISN 3 Network August 2006: No. of Prescriptions Overprescribed as per Guidelines: 50 Strips for 90 Days Site 1 Site 2 Site 3 Site 4 Site 5 TOTAL 4 1 1 3 8 17 January 2007: No. of Prescriptions Overprescribed as per Guidelines: 50 Strips for 180 Days 3 0 3 4 2 12 received the item. Therefore, we assumed that each patient received only one prescription of test strips during the allowed time period. On the basis of the 100 patients evaluated in January 2007, approximately 12 patients (12%) who were not using insulin received extra test strips. We conducted this medication usage evaluation (MUE) two months after the new computer software package was implemented. According to this review, VISN 3 could have saved $37.37 for the month of January 2007, with the potential savings of $448.44 annually on the 12 prescriptions in which the recommendation of 50 strips for 180 days was not followed. Compared with the August 2006 data, this was a decrease in potential cost savings. If we had extrapolated the January data to include the entire population of non-insulin users of test strips (13,740 patients), the potential projected annual savings would have been $61,623 if all prescriptions had been dispensed according to recommendations and refilled on the due date. Comparing August 2006 findings with those of January 2007, we found the net annual potential cost savings extrapolated for VISN 3 to be $241,568. Table 2 shows considerable differences in compliance within the VA medical center. Because these were VA patients, they were similar in demographics—typically men over 65 years of age—but there could have been several reasons for the discrepancies among sites. Some sites might have had health care After the initial prescribing visit, we did not determine further compliance; we assumed it. The VA’s computer system did not allow patients to receive refills more than one week early unless the health care provider cancelled the prescription and entered a new one. In reality, this is seldom done, however; if the provider tries to enter a new prescription for the same item, the system emits a warning that the patient has recently Table 3 Cost Savings for Glucose Test Strips at the VISN 3 Network August 2006 MUE Before Initiative Potential One-Month Cost Savings (N = 17)a Site 1 Site 2 Site 3 Site 4 Site 5 TOTAL Annual potential cost savings extrapolated for VISN 3 Net annual potential cost savings extrapolated for VISN 3 a,b,c January 2007 MUE After Initiative Potential One-Month Cost Savings (N = 12)d $12.46 $0.00 $7.47 $9.96 $7.48 $37.37 Potential Annual Extrapolated Cost Savings (N = 12)e $149.52 $0.00 $89.64 $119.52 $89.76 $448.44 Potential Annual Extrapolated Cost Savings (N = 17)b $626.88 $125.40 $125.40 $438.84 $889.92 $2,206.44 $52.24 $10.45 $10.45 $36.57 $74.16 $183.87 $303,191 (N = 2,336)c $241,568 $61,623 (N = 1,649)f Represent figures from the August 2006 medication usage evaluation (MUE). Of 100 charts reviewed, 17 prescriptions were written for an excess number of glucose test strips. c Represents cost savings that could be accrued if findings were extrapolated to the entire population of diabetic patients not using insulin and prescribed strips. Figure c depicts 17% of the entire number of test strip prescriptions for non–insulin-using patients (N = 13,740) for the entire Veterans Integrated System Network 3 (VISN 3). Therefore, 17% of 13,740 prescriptions = 2,336 prescriptions. If $2,206.44 could be saved annually for 17 prescriptions, $303,191 could be saved annually for 2,336 prescriptions if they were refilled on the due date. d,e,f Represent figures from the January 2007 MUE. In the 100 charts reviewed, 12 prescriptions were written for too many strips. f Represents cost savings that could be accrued if findings were extrapolated to the entire population of diabetic patients not using insulin who are prescribed test strips. Figure f depicts 12% of the total number of test strip prescriptions for non–insulin-using patients (N = 13,740) for the entire VISN; thus, 12% of 13,740 prescriptions = 1,649 prescriptions. If $448.44 could be saved annually for 12 prescriptions, $61,623 could be saved annually for 1,649 prescriptions if they were refilled on the due date. continued on page 165 160 P&T® • March 2008 • Vol. 33 No. 3
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