Adherence to the guidelines of a regional formulary

Stewart, Roy; Werf, GT van der; Schuling, Jan; Jong, Betty Meyboom-de; Kamps, Gerard Beno

doi:10.1093/fampra/17.3.254

Cited by 15 publications

(14 citation statements)

References 9 publications

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“…However, few studies have aimed to understand the relative importance of these different levels [7,26,27,37,44]. Moreover, even if adherence with guidelines in general is a well-developed research topic [1-3], as far we know only to investigations have been focused on adherence to guidelines of statin prescription, [45,46] and only our current and previous work has applied multilevel regression analyses [9]. The present investigation provides valuable and original information that could be of relevance for planning and evaluating interventions aimed to promote efficient and evidence-based prescription.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, adherence to prescription guidelines has attracted considerable interest in many countries [1-3], including Sweden [4-6]. However, it is still insufficiently known to what extent guidelines from the drug committees are followed and the factors that at different levels of the health care condition prescription adherence to recommended medication [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Merlo

2007

BMC Health Serv Res

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Merlo

2007

BMC Health Serv Res

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Section: ■■ Discussionmentioning

confidence: 99%

“…[13][14][15][16] Reported provider adherence to such local guidance generally ranges between 50% to 95%. 13,14,[16][17][18][19][20] Generally accepted rates for adherence to guidelines range from 80% to 90%. 17,18 These adherence rates were cited by studies whose scope ranges from very specific target populations (i.e., recombinant human coagulation factor VIIa prescribing at a single university teach-changed over time, finding that it did not.…”

Section: ■■ Discussionmentioning

confidence: 99%

Provider Prescribing of 4 Antiretroviral Agents After Implementation of Drug Use Guidelines in the Department of Veterans Affairs

Belperio¹,

Molé²,

Boothroyd³

et al. 2009

JMCP

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BACKGROUND: The Veterans Health Administration (VHA) develops guidelines for VHA providers that delineate specific criteria for use of certain complex, costly medications indicated for specialized populations. These criteria are disseminated to all VHA facilities.OBJECTIVE: To (a) assess the concordance with VHA guidelines for use of 4 antiretrovirals (atazanavir, darunavir, enfuvirtide, and tipranavir), and (b) to describe prescribing of these agents before and after implementation of the guideline criteria.METHODS: In this retrospective cohort study, we evaluated all veterans in VHA care who received their first outpatient prescription for a target antiretroviral between its FDA approval date and December 31, 2007, using outpatient prescription records obtained from the VHA Human Immunodeficiency Virus (HIV) Clinical Case Registry (CCR:HIV), an observational registry database created through extraction of specific clinical data from the VHA's electronic medical record. Adherence to the VHA guideline criteria was assessed using CCR:HIV data overall and during 3 time periods: (a) pre-criteria: from FDA approval date to criteria implementation date (range 38 days to 192 days), (b) early-criteria: the first 6 months after criteria implementation, and (c) late-criteria: from 180 days after criteria implementation until December 31, 2007 (range 184 days to 1,525 days).RESULTS: VHA providers prescribed target antiretroviral medications in accordance with the VHA guidelines for use more than 70% of the time.Comparing the pre-criteria with the post-criteria period (i.e., early-criteria and late-criteria combined), no significant differences in the percentages of veterans satisfying all VHA criteria were observed for any drug except atazanavir (P = 0.010). For atazanavir in the post-criteria period compared with the pre-criteria period, significantly more antiretroviral-naïve veterans met criteria for cardiovascular disease or risk (72.8% post-criteria vs. 45.5% pre-criteria, P = 0.045), and significantly more antiretroviral-experienced veterans met criteria for resistance to other protease inhibitors requiring the need for ritonavir-boosted atazanavir (61.7% vs. 50.5%, respectively, P < 0.001); however, fewer antiretroviral-experienced veterans met criteria for having documented intolerance to other protease inhibitors (78.9% vs. 89.9%, respectively, P < 0.001). Fewer darunavir-treated patients in the post-criteria period than in the pre-criteria period met the criteria for treatment experience including failure of at least 1 prior protease inhibitor regimen (87.8% vs. 96.0%, respectively, P = 0.002). Adherence to all darunavir criteria significantly waned over time (early-criteria 78.8% vs. late-criteria 62.5%, P < 0.001). Overall, adherence to atazanavir criteria increased over time (66.3% early-criteria vs. 72.9% late-criteria, P < 0.001).CONCLUSIONS: After implementation of antiretroviral specific guideline criteria, the proportion of veterans prescribed a target antiretroviral medication in accordance wit...

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“…4 Another study examining the effect of incentive-based formularies on prescription medication utilization and spending found similar reductions in medication spending; however, the study also found that patients were twice as likely to discontinue the use of their tier 3 medications. 10,11 No evidence was found that patients who had been using tier 3 medications and who stopped taking all medications in the class after the policy changes switched to alternative classes of medications.…”

Section: Previous Formulary-based Studiesmentioning

confidence: 99%

Potential Cost Savings for a Health System–Based Employee Outpatient Pharmacy

et al. 2010

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Hospitals everywhere are faced with the same dilemma as other companies, struggling to manage rising health care expenses while providing optimal care for their employees. One of the often overlooked drug expense is the drugs consumed by the facility's employees. Although the average pharmacy department manager has a considerable amount of experience and expertise in dealing with drug expense issues for inpatients or even classic outpatients, the path to optimizing the drug expense investment strategies for their fellow employees can be difficult and elusive to discern. This article should provide a pharmacy manager with a few examples of how to contain costs for employee outpatient pharmacies.Hosp Pharm-2010;45(6):472-477 M any facilities do not outsource the filling and resource management of employee prescriptions to outside pharmacies or a pharmacy benefits manager, therefore they are looking for strategies to ensure that the facility gets a good return on the investment it incurs in paying for its portion of employee prescriptions. For facilities that are selfinsured, the task takes on an increased level of urgency. This article should provide a pharmacy manager with a few examples of how to contain costs for employermanaged pharmacies.A key concern for employer-managed pharmacies is the need to develop treatment guidelines for outpatient services offered to their employees. Many hospitals have several years of experience in developing and using treatment guidelines for inpatients but are unsure how to manage treatment guidelines for outpatient areas. As the outpatient services provided by health systems grow and as the number of covered lives with medication benefits increases, medication costs for outpatients will continue to escalate rapidly. 1 The ability for employers to offer pharmacy services to employees grows more difficult, with obstacles consistently emerging to increase overall costs. Acquisition costs of prescription medications are rising, advertising may lead to inappropriate prescribing of more expensive medications, and the quantity of both prescriptions filled and prescription products available is increasing. 2 Outpatient medication costs account for 80% to 85% of the total medication cost to treat a population of patients; they are increasing at a rate of 10% annually and currently represent 11% of all health care expenditures. 2,3 Although medication spending remains relatively low for health care expenditures nationally, the share is much higher (20% to 25%) for working-aged adults with low rates of hospitalizations. 4 One of the most common ways to rein in prescription medication costs and to execute treatment

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Adherence to the guidelines of a regional formulary

Cited by 15 publications

References 9 publications

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Provider Prescribing of 4 Antiretroviral Agents After Implementation of Drug Use Guidelines in the Department of Veterans Affairs

Potential Cost Savings for a Health System–Based Employee Outpatient Pharmacy

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