Analyzing the Clinical Outcomes of a Rapid Mass Conversion From Rosuvastatin to Atorvastatin in a VA Medical Center Outpatient Setting

Abstract

Background: Medication conversions occur frequently within the Veterans Health Administration. This manual process involves several pharmacists over an extended period of time. Macros can automate the process of converting a list of patients from one medication to a therapeutic alternative. Objectives: To develop a macro that would convert active rosuvastatin prescriptions to atorvastatin and to create an electronic dashboard to evaluate clinical outcomes. Methods: A conversion protocol was approved by the Pharmacy & Therapeutics Committee. A macro was developed using Microsoft Visual Basic. Outpatients with active prescriptions for rosuvastatin were reviewed and excluded if they had a documented allergy to atorvastatin or a significant drug-drug interaction. An electronic dashboard was created to compare safety and efficacy endpoints pre-and postconversion. Primary endpoints included low-density lipoprotein (LDL), creatine phosphokinase (CPK), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase. Secondary endpoints evaluated cardiovascular events, including the incidences of myocardial infarction, stroke, and stent placement. Results: The macro was used to convert 1520 patients from rosuvastatin to atorvastatin over a period of 20 hours saving $5760 in pharmacist labor. There were no significant changes in LDL, AST, ALT, or secondary endpoints (P > .05). There was a significant increase in alkaline phosphatase (P = .0035). Conclusions: A rapid mass medication conversion from rosuvastatin to atorvastatin saved time and money and resulted in no clinically significant changes in safety or efficacy endpoints. Macros and clinical dashboards can be applied to any Veterans Health Administration facility.

The impact of non-medical switching among ambulatory patients: an updated systematic literature review

“…The initial search strategy yielded 3,177 citations and an additional 14 citations were manually identified (Figure 1). After screening and full-text assessment, 38 studies (11 studies added based on the updated search) with a total of 260,256 patients (median: 591; range: 31-102,076) and a median follow-up of 6 months (range: 0.5 to 18 months) were included in our review (Table 2) [8][9][10][11][12][13][14][15][16][17][18]. A total of 26 studies (68.4%) were published between 2000 and 2014, while 12 (31.6%) were published between 2015 and 2018.…”

“…Since the publication of this prior systematic review, a great deal of attention has been paid to the consequences of non-medical switching by medical and patient advocate organizations and state legislatures [4][5][6][7] and new studies/ data have been generated and published [8][9][10][11][12][13][14][15][16][17][18]. Both the Cochrane Handbook for Systematic Reviews of Interventions [19] and the methods guide for the Agency for Healthcare Research and Quality (AHRQ) Evidencebased Practice Center program [20] remark on the importance of updating of a systematic review as new evidence becomes available.…”