Background Increased rate of inappropriate drug use in combination with limited funding made imperative the implementation of restrictions in order to regulate highly-prescribed drugs consumption, such as ferric carboxymaltose (FC) and human albumin (HA). Additionally, limited availability of HA imposed its use exclusively to evidence-based indications.
To this end, mandatory completion of a designed order form (DOF) for the above-mentioned medicines was introduced as a prerequisite in hospital daily practice.
Purpose To clarify the efficacy of pharmacy intervention (PI) in decreasing irrational drug use and produce a better drug management system.
Material and methods An observational study in a tertiary hospital (945 beds) was conducted in two phases. Data, in the first phase (January 2013–May 2018) were analysed retrospectively, while in the second phase (from June 2018) were studied after PI.
Concerning FC, PI refers to DOF completion where ferritin serum value and previous oral administration of ferric formulations were considered.
As for HA, strict adjustment to clinical guidelines and evidence-based indications were applied throughout the local protocol, along with 2 day treatment per prescription.
Total and per clinic FC and HA monthly average consumption data in the pre- and post-guideline implementation phase was conducted. Moreover, average drug cost was calculated.
Results An augmentative trend throughout the first study period was observed in the overall FC average monthly consumption. Significant variations in FC prescription profiles in clinics of similar specialty were detected. DOF implementation resulted in an overall downsizing of FC utilisation (57%) and prescribers’ modification mentality.
Up to December 2017 HA use presented slight differences (25 kg/per month), whereas limited HA supply during the first semester of 2018 led to an expected consumption decline (15 kg/per month). However, the evidence-based HA administration in combination with the DOF adoption revealed further reduction (7 kg/per month) and effective stock management.
DOF implementation for FC and HA resulted in a cost reduction of €16,000/month and €40,000/month, respectively, which corresponds to €672,000/year.
Conclusion The evaluation of PI showed its necessity in order to guarantee the rationalised use of high-cost medications associated with anticipated prescription accuracy and compliance. Due to encouraging results, PI measures in other drugs have been implemented (human immunoglobulin and antibiotics).
References and/or acknowledgements https://doi.org/10.1093/bja/aep393
No conflict of interest.
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