Clinical and Economic Outcomes of Pharmacist-Managed Antiepileptic Drug Therapy

Abstract

This study explores the associations between pharmacist-managed antiepileptic drug therapy in hospitalized Medicare patients and diagnoses indicating the need for these drugs. It also explores the following major heath care outcomes: death rate, hospital length of stay (LOS), Medicare charges, drug charges, laboratory charges, complications, and adverse drug reactions. Data were drawn from the 1998 MedPAR and 1998 National Clinical Pharmacy Services databases. Pharmacist-managed antiepileptic drug therapy was evaluated in a study population of 9380 Medicare patients with diagnosed epilepsy or seizure disorders treated in 794 United States hospitals. This population was derived from the 38,311 hospitalized Medicare patients with epilepsy or seizure disorders (MedPAR). In hospitals without pharmacist-managed antiepileptic drug therapy, death rates were 120.61% higher, with 374 excess deaths (chi(2)=5.983, df=1, p=0.014, odds ratio [OR]=1.553, 95% confidence interval [CI] 1.102-2.189). Hospital LOS was 14.68% higher, with 8069 patient-days (Mann-Whitney U test [U]=3833132, p=0.0009); total Medicare charges were 11.19% higher, with 14,372,550 dollars in excess total charges (U=3644199, p=0.0003); per-patient drug charges were $115 +/- $92 higher (p=NS); laboratory charges were 32.24% higher, with 5,664,970 dollars in excess charges; and aspiration pneumonia rate was 54.61% higher (chi(2)=5.848, df=1, p=0.015, OR=1.233, 95% CI 1.081-1.901). Although the frequencies of other complications and adverse effects were higher, these differences were not statistically significant compared with hospitals with pharmacist-managed antiepileptic drug therapy. Clinical and economic outcomes were improved among hospitalized Medicare patients whose antiepileptic drug therapy was managed by pharmacists.

Cost-effectiveness analysis for the use of serum antiepileptic drug level monitoring in children diagnosed with structural-metabolic epilepsy

“…The same conclusion was determined, which was that ''TDM of antiepileptic drugs can be cost-effective''. However, in this review, an additional retrospective observational study was used to support the stated conclusion (Bond and Raehl, 2006). In that study, hospitals without pharmacists who managed AED therapy showed a higher rate of death, higher length of hospital stay, higher total Medicare charges, higher laboratory charges, and a higher rate of aspiration pneumonia than hospitals with pharmacist-managed AED therapy.…”

Clinical Pharmacy Services, Pharmacy Staffing, and Hospital Mortality Rates

“…55 Previous large-scale studies on pharmacist-provided drug therapy management found that hospitals without this service had 4664 more deaths from heparin, 2786 more deaths from warfarin, 1048 more deaths from aminoglycosides or vancomycin, and 374 more deaths from antiepileptic drugs when compared with hospitals that have pharmacists who manage these drugs. 46,47,56 Drug management (any drug) by pharmacists is the fastest growing clinical pharmacy service in U.S. hospitals. This clinical pharmacy service was present in 25% of the hospitals in 1989 23 and 70% of hospitals in 1998 (a 180% increase).…”

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

“…Pharmacist-managed aminoglycoside, vancomycin, and antiepileptic therapy has been associated with significantly improved economic and clinical outcomes in Medicare patients. 5,6 Impacts in terms of attaining goals of therapy have also been demonstrated, specifically with pharmacist-managed lipid clinics. 7 In the community setting, studies have demonstrated a lack of laboratory monitoring for medications.…”