Implementation of a therapeutic-interchange clinic for HMG-CoA reductase inhibitors

A therapeutic-interchange clinic for statins is described. In 1999, the Department of Defense mandated the use of cerivastatin and simvastatin as the formulary statins in all military health care facilities by April 2000. Cerivastatin was the preferred agent; the goal was to use this agent in 60-65%...

Full description

Saved in:

Bibliographic Details
Published in:	American journal of health-system pharmacy Vol. 59; no. 11; pp. 1077 - 1082
Main Authors:	Grace, KA, Swiecki, J, Hyatt, R, Gibbs, H, Jones, DL, Sheikh, M, Spain, J, Maneval, KW, Viola, R, Taylor, AJ
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Bethesda, MD ASHP 01-06-2002 American Society of Health Pharmacists
Subjects:	Aged Ambulatory Care Facilities - economics Ambulatory Care Facilities - organization & administration Biological and medical sciences Female General and cellular metabolism. Vitamins Hospitals, Military - economics Hospitals, Military - organization & administration Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Male Medical sciences Middle Aged Monitoring, Physiologic - economics Monitoring, Physiologic - methods Patient Education as Topic - economics Patient Education as Topic - methods Patient Education as Topic - organization & administration Pharmacology. Drug treatments Pyridines - economics Pyridines - therapeutic use Simvastatin - economics Simvastatin - therapeutic use United States North America America Human Enzyme Enzyme inhibitor Statin derivative Cerivastatin Drug conversion Chemotherapy Treatment Health economy Atorvastatin Hydroxymethylglutaryl-CoA reductase Oxidoreductases Ambulatory Hospital Cost analysis Public health Antilipemic agent Military
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	A therapeutic-interchange clinic for statins is described. In 1999, the Department of Defense mandated the use of cerivastatin and simvastatin as the formulary statins in all military health care facilities by April 2000. Cerivastatin was the preferred agent; the goal was to use this agent in 60-65% of all patients. Walter Reed Army Medical Center developed a voluntary therapeutic-interchange clinic for patients receiving statins. Goals included facilitating the rapid switching of patients to the formulary statins, maximizing the use of the preferred agent, maintaining or improving lipid control, monitoring safety, determining costs, educating patients about their treatment, and documenting satisfaction with the clinic. Written educational materials were prepared, an algorithm for statin conversion was created, and laboratory tests were performed, among other measures. Between January and April 2000, 1356 patients were seen by the therapeutic-interchange clinic; of these, 942 agreed to have the efficacy and safety of their therapy monitored by the clinic. Before the formulary change, the most commonly prescribed statins were atorvastatin (44% of patients) and pravastatin (42%). Under the conversion policy, 96% of patients received cerivastatin and 4% simvastatin. The percentage of patients achieving their targeted low-density-lipoprotein cholesterol concentration increased from 65% to 75%. The policy saved an average of $115 per patient in the first year. Most patients were satisfied with the clinic, but only 36% of providers were satisfied. Cerivastatin was withdrawn from the market in August 2001; simvastatin became the only formulary statin. A therapeutic-interchange clinic at a military medical center provided an efficient means of switching a large number of patients to alternative statin therapy, monitoring the outcomes, and individualizing patient care.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1079-2082 1535-2900
DOI:	10.1093/ajhp/59.11.1077