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ANTICOAGULATION

Impact of Prescribing Guidelines for Inpatient Anticoagulation

Director, Center for Pharmacoeconomic Research; Associate Professor, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL

Juan C Blackburn, MD MBA

Research Fellow, Center for Pharmacoeconomic Research, University of Illinois at Chicago

Edith A Nutescu, PharmD

Director, Antithrombosis Services; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

Surrey M Walton, PhD

Assistant Professor, Center for Pharmacoeconomic Research, Department of Pharmacy Administration, University of Illinois at Chicago

Jamie M Finley, PharmD

Coordinator of Clinical Pharmacy Programs, Mercy Resource Management Inc., Naperville, IL; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

Richard K Lewis, PharmD MBA

Vice President, Pharmacy Services, Mercy Resource Management Inc.; Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago

Reprints: Glen T Schumock PharmD MBA FCCP, 833 S. Wood St. (MC 886), Chicago, IL 60612-7230, fax 312/996-0379, schumock{at}uic.edu

BACKGROUND: Anticoagulants are widely used and represent a class of drugs that are problem-prone and have a high potential for adverse patient outcomes. As such, these drugs may be amenable to the use of prescribing guidelines. However, relatively little has been published on the effect of such guidelines on clinical outcomes or costs of care.

OBJECTIVE: To assess whether guidelines improve the appropriateness of prescribing, clinical outcomes, and costs associated with use of anticoagulants in a sample of community hospitals in the US.

METHODS: A retrospective analysis was performed of data voluntarily collected by 15 hospitals before (July–September 2001) and after (March–May 2002) implementation of anticoagulant prescribing guidelines. Statistical analyses of both patient- and hospital-level variables were conducted.

RESULTS: Implementation of the guidelines resulted in a significant increase in the proportion of anticoagulants that were prescribed appropriately (59.8% vs 86.9%; p < 0.001). The guidelines also resulted in a shift in the type of anticoagulants prescribed (decreased use of unfractionated heparin and increased use of low-molecular-weight heparins). There was suggestive evidence, although not statistically significant, that the guidelines resulted in fewer anticoagulant-associated adverse events (total bleeding RR 0.71) and lower costs (savings of $56.15 per patient per day).

CONCLUSIONS: While limitations existed with the study design, sufficient benefits were identified to warrant hospitals to consider use of these or similar guidelines on a routine basis. Clearly, additional study in this area would be useful.

Key Words: anticoagulants, costs, low-molecular-weight heparins, medication use evaluation, outcomes, prescribing guidelines

Published Online, August 10, 2004. www.theannals.com, DOI 10.1345/aph.1E121

This article has been cited by other articles:

				V. Vats, E. A. Nutescu, J. C. Theobald, J. E. Wojtynek, and G. T. Schumock Survey of hospitals for guidelines, policies, and protocols for anticoagulants Am. J. Health Syst. Pharm., June 1, 2007; 64(11): 1203 - 1208. [Abstract] [Full Text] [PDF]