Letters
All 10 participants who completed the semistructured interviews reported overall satisfaction with the counseling intervention. Of these 10 participants, 9 reported improved inhaler use (i.e., changes in inhalation technique, improved frequency of use, proper spacing of inhalations, and recapping of inhalers) as the result of an intervention. Participants also expressed appreciation for receiving the intervention via telephone rather than being required to travel to a clinic. Discussion. This study demonstrated the feasibility of a telepharmacy counseling intervention to improve veterans’ use of inhaled medications for COPD. Initial enrollment goals were met, and 97% of participants completed the study. In addition, participants reported incorporating techniques learned from the pharmacists into their inhaler use and gave positive feedback regarding their experience with telepharmacy counseling (e.g., reduced travel for health care). Future research examining telepharmacy should be adequately powered to assess the clinical impact on COPD morbidity measures. 1. Restrepo RD, Alvarez MT, Wittnebel LD et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008; 3:371-84. 2. Melani AS, Bonavia M, Cilenti V et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011; 105:930-8. 3. Khdour MR, Kidney JC, Smyth BM et al. Clinical pharmacy-led disease and medicine management programme for patients with COPD. Br J Clin Pharmacol. 2009; 68:588-98. 4. Effing T, Monninkhof EM, van der Valk PD et al. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007; 4:CD002990. 5. Weinberger M, Murray MD, Marrero DG et al. Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA. 2002; 288:1594-602. 6. Cone SM, Brown MC, Stambaugh RL. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers: an update. Am J Health-Syst Pharm. 2008; 65:631-5. 7. Department of Veterans Affairs. Make room for patient centered care: patient aligned care team (PACT). www.va.gov/ primarycare/pcmh (accessed 2012 Apr 14).
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8. Young HN, Havican SN, Griesbach S et al. Patient and pharmacist telephonic encounters (PARTE) in an underserved rural patient population with asthma: results of a pilot study. Telemed J E Health. 2012; 18:427-33.
Amanda Margolis, Pharm.D., M.S., BCACP, Research Assistant School of Pharmacy University of Wisconsin—Madison Madison, WI Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital 2500 Overlook Terrace Madison, WI 53705 [email protected] Henry Young, Ph.D., Kroger Professor, Associate Professor Clinical and Administrative Pharmacy University of Georgia College of Pharmacy Athens, GA Jennifer Lis, Pharm.D., BCACP, Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital Arthur Schuna, M.S.Pharm., BCACP, FASHP, Pharmacy Residency Director William S. Middleton Memorial Veterans Hospital
Christine A. Sorkness, Pharm.D., Professor of Pharmacy and Medicine Schools of Pharmacy and Medicine and Public Health University of Wisconsin—Madison Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital The assistance of David Heineman with participant interviews and the Veterans Health Administration is acknowledged. This study was funded by the American Society of Health-System Pharmacists Research and Education Foundation Fostering Young Investigators Federal Services Junior Investigator Research Grant. This study was also supported by the Clinical and Translational Science Award program, previously through National Center for Research Resources grant 1UL1RR025011 and now by National Center for Advancing Translational Sciences grant 9U54TR000021. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120241
Validity and reliability of a practitioner service tool: Potential resource for assessing faculty practitioners
A
greements between colleges of pharmacy and affiliated practice sites allow faculty members to provide contemporary clinical pharmacy service while educating pharmacy students during pharmacy practice experiences.1 Assessment of the faculty member’s clinical pharmacy service is necessary to determine the impact he or she has at an affiliated practice site.1 If high-quality clinical pharmacy service can be reliably and quantitatively assessed, this could strengthen the faculty member’s annual performance evaluation and application for promotion and tenure. Based on the need to provide consistent evaluation
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
among numerous pharmacy practice sites, a pilot study was conducted to develop and measure the reliability of an assessment tool used to evaluate a pharmacy practitioner’s clinical service. The major competencies from an American College of Clinical Pharmacy white paper on clinical pharmacist competencies were used as the primary headings when developing the assessment tool.2 In addition, interpersonal skills and character traits such as integrity were included as part of the assessment to fully evaluate the working relationships that faculty have in their respective institutions.3 A scale was developed
Letters
for the evaluators to rank practitioners using outstanding, proficient, and needs improvement (eFigure; available with the full text of this Letter at www.ajhp.org). The assessment tool was evaluated for face validity by two experts in pharmacy practice who have experience evaluating pharmacy practice faculty, and modifications were made. To test the reliability of the assessment tool, 2 pharmacists in supervisory positions completed assessments for the same 20 staff members. The pharmacists who were evaluated performed similar clinical duties as college faculty members but were not faculty members. The supervisors coded, completed, and returned the evaluations to the principal investigator. Descriptive statistics including mean and standard deviations provided the ba-
sic characteristics of the data. For statistical analysis of reliability, only the response options outstanding, proficient, and needs improvement were included and were coded as 1, 2, and 3, respectively. Any individual item in the tool marked as not applicable or do not know for more than 15% of the survey respondents was dropped from the analysis. Hence, the original 28item tool was reduced to 22 items. A total of 40 observations were recorded by the 2 raters, who evaluated 20 practitioners. The ratings for each item are shown in the table. Overall, the 22item scale was reliable, as it showed a Cronbach’s coefficient alpha of 0.97 (p < 0.05). When the item-to-total correlations were observed, the Cronbach coefficient alpha would have increased to 0.967 if the items integrity, avail-
ability, and exhibits an encouraging and positive can-do attitude were removed. These items also had the lowest itemtotal correlations (0.36, 0.46, and 0.60, respectively). After careful consideration, it was decided that these items should be retained, especially since the component loadings were well above the a priori selected criterion of 0.50 (0.82, 0.91, and 0.87, respectively). The interitem correlation matrix was examined, and the correlations between the 22 items were found to be moderate, with ranges from 0.09 to 0.94. The items with low correlations were the previous 3 items with the lowest item-total correlations. Using a two-way randomeffects model with absolute agreement, the intraclass coefficient was 0.96 (95% confidence interval, 0.94–0.98; p < 0.05),
Descriptive Statistics and Internal Reliability of Items in the Assessment Toola Item
Mean ± S.D. Scoreb
Cronbach’s Coefficient Alpha (if Item Deleted)
Displays knowledge/expertise required for this position Serves as a resource for members of the health care team Promotes safe and appropriate medication therapies for patients Assist in development, implementation, and maintenance of clinical pharmacy services Effectively documents clinical pharmacy actions and activities per pharmacy policy Provide accurate, adequate, and timely drug information to professional staff Attend and participate in appropriate affiliated site meetings Effective verbal communication with health care professionals Effective written communication with health care professionals Information synthesis Provides sound scientific basis for answers Articulates medical information assigned Keep abreast of current medical and therapeutic information Patient care Supports pharmacy staff in the provision of pharmaceutical care services Follows projects through to ontime completion Integrity Willingly explores new approaches Stimulates innovation and new ideas Availability Exhibits an encouraging and positive can-do attitude Generally a strong and effective pharmacy practice practitioner, taking multiple characteristics into consideration
2.33 ± 0.55 2.33 ± 0.55 2.41 ± 0.50
0.963 0.964 0.964
2.04 ± 0.71
0.963
2.30 ± 0.61
0.965
2.26 ± 0.53 2.22 ± 0.51 2.41 ± 0.57 2.33 ± 0.55 2.41 ± 0.57 2.41 ± 0.57 2.26 ± 0.53 2.26 ± 0.66 2.37 ± 0.49
0.964 0.964 0.964 0.964 0.963 0.963 0.964 0.962 0.963
2.30 ± 0.61 2.41 ± 0.57 2.59 ± 0.50 2.15 ± 0.82 2.26 ± 0.76 2.37 ± 0.49 2.15 ± 0.82
0.964 0.965 0.967 0.966 0.963 0.967 0.967
2.37 ± 0.57
0.963
Any individual item in the tool marked as not applicable or do not know for more than 15% of the survey respondents was dropped from the analysis. The following six items were deleted: (1) prepare and present pharmacy information for various committees as assigned, (2) participate in the department/institutional performance process, (3) conflict and dispute resolution, (4) effective verbal communication with patients, (5) effective written communication with patients, and (6) report adverse drug reactions and variances per institutional procedures. b Scores for outstanding, proficient, and needs improvement were coded as 1, 2, and 3, respectively. a
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
1877
Letters
showing excellent agreement between the raters. Given the lack of other tools and research in the area of clinical pharmacy service evaluation, this assessment tool is a preliminary step in designing a method for evaluation. Preliminary evidence suggests that this tool may provide affiliated institutions a reliable means to evaluate faculty members, thereby strengthening relationships with colleges of pharmacy and documenting the faculty member’s overall performance. 1. Ray MD, Boucher BA. Strengthening relationships between pharmacy faculty members and clinical training sites. Am J Health-Syst Pharm. 2010; 67:1558-62. 2. Burke JM, Miller WA, Spencer AP et al. Clinical pharmacist competencies. Pharmacotherapy. 2008; 28:806-15.
3. American Society of Health-System Pharmacists. ASHP statement on professionalism. Am J Health-Syst Pharm. 2008; 65:172-4.
Joe D. Strain, Pharm.D., Associate Professor of Pharmacy Practice Pharmacy Department South Dakota State University 353 Fairmont Boulevard Rapid City, SD 57702 [email protected] Debra K. Farver, Pharm.D., Professor of Pharmacy Practice South Dakota State University Yankton, SD
yopathy and rhabdomyolysis resulting from the coadministration of simvastatin and amiodarone have previously been described.1,2 To minimize this risk, FDA has limited the maximum dosage of simvastatin to 20 mg daily when coadministered with amiodarone.2 However, doses of simvastatin 40 and 80 mg daily are still commonly coprescribed with amiodarone in practice.3,4 Computerized provider order entry may offer a solution to this problem by providing alerts to prescribers regarding drug–drug interactions (DDIs) at order entry.5 The original DDI alert for the interaction between amiodarone and simvastatin at our study site contained 299 words, and providers had to scroll past extraneous background information to view the available management recommendations. A more-efficient dose-specific alert was developed and implemented on July 5, 2011. The revised DDI alert contained 14 words and provided recommendations about drug management. This alert was a hard stop, so providers could not pro-
1878
Olayinka O. Shiyanbola, Ph.D., Assistant Professor of Pharmacy Practice South Dakota State University Sioux Falls, SD The assistance of Jeffrey C. Delafuente, M.S., FCCP, FASCP, is acknowledged. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120462
Jodi R. Heins, Pharm.D., Assistant Department Head and Professor of Pharmacy Practice South Dakota State University Sioux Falls, SD
Effect of simvastatin–amiodarone drug interaction alert on appropriate prescribing
M
Jane R. Mort, Pharm.D., Associate Dean for Academic Programs South Dakota State University Brookings, SD
ceed past the alert without changing the order. The electronic records of 40 consecutive patients who were admitted to a 60-bed cardiology service for a twomonth intervention period (August 28 to November 5, 2011) were compared with those of 43 consecutive patients admitted to the same units during a twomonth baseline period (March 1 to April 30, 2011). There was a four-month gap between study periods to allow for staff education about the revised alert. Electronic records were eligible for evaluation if the patient had concomitant orders for amiodarone and any statin. The primary endpoint was the percentage of appropriate simvastatin orders entered for patients also receiving amiodarone. An appropriate order was defined as an order for simvastatin of ≤20 mg/day for the original alert and ≤10 mg/day for the revised alert. The dosage limits for simvastatin were different for the original and the revised alerts because, in June 2011, FDA changed the maximum recommended dosage of simvastatin when
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
coprescribed with amiodarone to 10 mg daily.6 Although FDA subsequently changed the maximum recommended dosage of simvastatin back to 20 mg daily when coprescribed with amiodarone in October 2011, 10 mg daily was the FDArecommended dosage during our intervention period. The rates of musclerelated adverse effects, including muscle pain, myopathy, and rhabdomyolysis, were also evaluated. Student’s t test was used to compare continuous variables. Categorical variables were analyzed using Fisher’s exact test. The a priori level of significance was 0.05. Baseline characteristics were similar between groups, except for ventricular arrhythmia, which was more common in the control group (58% versus 18%, p < 0.001). Simvastatin orders were appropriate for all 10 patients in the intervention group for whom simvastatin and amiodarone were coprescribed, compared with 9 (56%) of 16 patients in the control group (p = 0.02). Among the 44% of inappropriate simvastatin orders in the control group, 43% were subsequently changed to an appropriate order during the patients’ hospitalization. One hundred percent of orders in the intervention group for any statin coad-
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
All 10 participants who completed the semistructured interviews reported overall satisfaction with the counseling intervention. Of these 10 participants, 9 reported improved inhaler use (i.e., changes in inhalation technique, improved frequency of use, proper spacing of inhalations, and recapping of inhalers) as the result of an intervention. Participants also expressed appreciation for receiving the intervention via telephone rather than being required to travel to a clinic. Discussion. This study demonstrated the feasibility of a telepharmacy counseling intervention to improve veterans’ use of inhaled medications for COPD. Initial enrollment goals were met, and 97% of participants completed the study. In addition, participants reported incorporating techniques learned from the pharmacists into their inhaler use and gave positive feedback regarding their experience with telepharmacy counseling (e.g., reduced travel for health care). Future research examining telepharmacy should be adequately powered to assess the clinical impact on COPD morbidity measures. 1. Restrepo RD, Alvarez MT, Wittnebel LD et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008; 3:371-84. 2. Melani AS, Bonavia M, Cilenti V et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011; 105:930-8. 3. Khdour MR, Kidney JC, Smyth BM et al. Clinical pharmacy-led disease and medicine management programme for patients with COPD. Br J Clin Pharmacol. 2009; 68:588-98. 4. Effing T, Monninkhof EM, van der Valk PD et al. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007; 4:CD002990. 5. Weinberger M, Murray MD, Marrero DG et al. Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA. 2002; 288:1594-602. 6. Cone SM, Brown MC, Stambaugh RL. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers: an update. Am J Health-Syst Pharm. 2008; 65:631-5. 7. Department of Veterans Affairs. Make room for patient centered care: patient aligned care team (PACT). www.va.gov/ primarycare/pcmh (accessed 2012 Apr 14).
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8. Young HN, Havican SN, Griesbach S et al. Patient and pharmacist telephonic encounters (PARTE) in an underserved rural patient population with asthma: results of a pilot study. Telemed J E Health. 2012; 18:427-33.
Amanda Margolis, Pharm.D., M.S., BCACP, Research Assistant School of Pharmacy University of Wisconsin—Madison Madison, WI Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital 2500 Overlook Terrace Madison, WI 53705 [email protected] Henry Young, Ph.D., Kroger Professor, Associate Professor Clinical and Administrative Pharmacy University of Georgia College of Pharmacy Athens, GA Jennifer Lis, Pharm.D., BCACP, Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital Arthur Schuna, M.S.Pharm., BCACP, FASHP, Pharmacy Residency Director William S. Middleton Memorial Veterans Hospital
Christine A. Sorkness, Pharm.D., Professor of Pharmacy and Medicine Schools of Pharmacy and Medicine and Public Health University of Wisconsin—Madison Clinical Pharmacy Specialist William S. Middleton Memorial Veterans Hospital The assistance of David Heineman with participant interviews and the Veterans Health Administration is acknowledged. This study was funded by the American Society of Health-System Pharmacists Research and Education Foundation Fostering Young Investigators Federal Services Junior Investigator Research Grant. This study was also supported by the Clinical and Translational Science Award program, previously through National Center for Research Resources grant 1UL1RR025011 and now by National Center for Advancing Translational Sciences grant 9U54TR000021. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120241
Validity and reliability of a practitioner service tool: Potential resource for assessing faculty practitioners
A
greements between colleges of pharmacy and affiliated practice sites allow faculty members to provide contemporary clinical pharmacy service while educating pharmacy students during pharmacy practice experiences.1 Assessment of the faculty member’s clinical pharmacy service is necessary to determine the impact he or she has at an affiliated practice site.1 If high-quality clinical pharmacy service can be reliably and quantitatively assessed, this could strengthen the faculty member’s annual performance evaluation and application for promotion and tenure. Based on the need to provide consistent evaluation
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
among numerous pharmacy practice sites, a pilot study was conducted to develop and measure the reliability of an assessment tool used to evaluate a pharmacy practitioner’s clinical service. The major competencies from an American College of Clinical Pharmacy white paper on clinical pharmacist competencies were used as the primary headings when developing the assessment tool.2 In addition, interpersonal skills and character traits such as integrity were included as part of the assessment to fully evaluate the working relationships that faculty have in their respective institutions.3 A scale was developed
Letters
for the evaluators to rank practitioners using outstanding, proficient, and needs improvement (eFigure; available with the full text of this Letter at www.ajhp.org). The assessment tool was evaluated for face validity by two experts in pharmacy practice who have experience evaluating pharmacy practice faculty, and modifications were made. To test the reliability of the assessment tool, 2 pharmacists in supervisory positions completed assessments for the same 20 staff members. The pharmacists who were evaluated performed similar clinical duties as college faculty members but were not faculty members. The supervisors coded, completed, and returned the evaluations to the principal investigator. Descriptive statistics including mean and standard deviations provided the ba-
sic characteristics of the data. For statistical analysis of reliability, only the response options outstanding, proficient, and needs improvement were included and were coded as 1, 2, and 3, respectively. Any individual item in the tool marked as not applicable or do not know for more than 15% of the survey respondents was dropped from the analysis. Hence, the original 28item tool was reduced to 22 items. A total of 40 observations were recorded by the 2 raters, who evaluated 20 practitioners. The ratings for each item are shown in the table. Overall, the 22item scale was reliable, as it showed a Cronbach’s coefficient alpha of 0.97 (p < 0.05). When the item-to-total correlations were observed, the Cronbach coefficient alpha would have increased to 0.967 if the items integrity, avail-
ability, and exhibits an encouraging and positive can-do attitude were removed. These items also had the lowest itemtotal correlations (0.36, 0.46, and 0.60, respectively). After careful consideration, it was decided that these items should be retained, especially since the component loadings were well above the a priori selected criterion of 0.50 (0.82, 0.91, and 0.87, respectively). The interitem correlation matrix was examined, and the correlations between the 22 items were found to be moderate, with ranges from 0.09 to 0.94. The items with low correlations were the previous 3 items with the lowest item-total correlations. Using a two-way randomeffects model with absolute agreement, the intraclass coefficient was 0.96 (95% confidence interval, 0.94–0.98; p < 0.05),
Descriptive Statistics and Internal Reliability of Items in the Assessment Toola Item
Mean ± S.D. Scoreb
Cronbach’s Coefficient Alpha (if Item Deleted)
Displays knowledge/expertise required for this position Serves as a resource for members of the health care team Promotes safe and appropriate medication therapies for patients Assist in development, implementation, and maintenance of clinical pharmacy services Effectively documents clinical pharmacy actions and activities per pharmacy policy Provide accurate, adequate, and timely drug information to professional staff Attend and participate in appropriate affiliated site meetings Effective verbal communication with health care professionals Effective written communication with health care professionals Information synthesis Provides sound scientific basis for answers Articulates medical information assigned Keep abreast of current medical and therapeutic information Patient care Supports pharmacy staff in the provision of pharmaceutical care services Follows projects through to ontime completion Integrity Willingly explores new approaches Stimulates innovation and new ideas Availability Exhibits an encouraging and positive can-do attitude Generally a strong and effective pharmacy practice practitioner, taking multiple characteristics into consideration
2.33 ± 0.55 2.33 ± 0.55 2.41 ± 0.50
0.963 0.964 0.964
2.04 ± 0.71
0.963
2.30 ± 0.61
0.965
2.26 ± 0.53 2.22 ± 0.51 2.41 ± 0.57 2.33 ± 0.55 2.41 ± 0.57 2.41 ± 0.57 2.26 ± 0.53 2.26 ± 0.66 2.37 ± 0.49
0.964 0.964 0.964 0.964 0.963 0.963 0.964 0.962 0.963
2.30 ± 0.61 2.41 ± 0.57 2.59 ± 0.50 2.15 ± 0.82 2.26 ± 0.76 2.37 ± 0.49 2.15 ± 0.82
0.964 0.965 0.967 0.966 0.963 0.967 0.967
2.37 ± 0.57
0.963
Any individual item in the tool marked as not applicable or do not know for more than 15% of the survey respondents was dropped from the analysis. The following six items were deleted: (1) prepare and present pharmacy information for various committees as assigned, (2) participate in the department/institutional performance process, (3) conflict and dispute resolution, (4) effective verbal communication with patients, (5) effective written communication with patients, and (6) report adverse drug reactions and variances per institutional procedures. b Scores for outstanding, proficient, and needs improvement were coded as 1, 2, and 3, respectively. a
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
1877
Letters
showing excellent agreement between the raters. Given the lack of other tools and research in the area of clinical pharmacy service evaluation, this assessment tool is a preliminary step in designing a method for evaluation. Preliminary evidence suggests that this tool may provide affiliated institutions a reliable means to evaluate faculty members, thereby strengthening relationships with colleges of pharmacy and documenting the faculty member’s overall performance. 1. Ray MD, Boucher BA. Strengthening relationships between pharmacy faculty members and clinical training sites. Am J Health-Syst Pharm. 2010; 67:1558-62. 2. Burke JM, Miller WA, Spencer AP et al. Clinical pharmacist competencies. Pharmacotherapy. 2008; 28:806-15.
3. American Society of Health-System Pharmacists. ASHP statement on professionalism. Am J Health-Syst Pharm. 2008; 65:172-4.
Joe D. Strain, Pharm.D., Associate Professor of Pharmacy Practice Pharmacy Department South Dakota State University 353 Fairmont Boulevard Rapid City, SD 57702 [email protected] Debra K. Farver, Pharm.D., Professor of Pharmacy Practice South Dakota State University Yankton, SD
yopathy and rhabdomyolysis resulting from the coadministration of simvastatin and amiodarone have previously been described.1,2 To minimize this risk, FDA has limited the maximum dosage of simvastatin to 20 mg daily when coadministered with amiodarone.2 However, doses of simvastatin 40 and 80 mg daily are still commonly coprescribed with amiodarone in practice.3,4 Computerized provider order entry may offer a solution to this problem by providing alerts to prescribers regarding drug–drug interactions (DDIs) at order entry.5 The original DDI alert for the interaction between amiodarone and simvastatin at our study site contained 299 words, and providers had to scroll past extraneous background information to view the available management recommendations. A more-efficient dose-specific alert was developed and implemented on July 5, 2011. The revised DDI alert contained 14 words and provided recommendations about drug management. This alert was a hard stop, so providers could not pro-
1878
Olayinka O. Shiyanbola, Ph.D., Assistant Professor of Pharmacy Practice South Dakota State University Sioux Falls, SD The assistance of Jeffrey C. Delafuente, M.S., FCCP, FASCP, is acknowledged. The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120462
Jodi R. Heins, Pharm.D., Assistant Department Head and Professor of Pharmacy Practice South Dakota State University Sioux Falls, SD
Effect of simvastatin–amiodarone drug interaction alert on appropriate prescribing
M
Jane R. Mort, Pharm.D., Associate Dean for Academic Programs South Dakota State University Brookings, SD
ceed past the alert without changing the order. The electronic records of 40 consecutive patients who were admitted to a 60-bed cardiology service for a twomonth intervention period (August 28 to November 5, 2011) were compared with those of 43 consecutive patients admitted to the same units during a twomonth baseline period (March 1 to April 30, 2011). There was a four-month gap between study periods to allow for staff education about the revised alert. Electronic records were eligible for evaluation if the patient had concomitant orders for amiodarone and any statin. The primary endpoint was the percentage of appropriate simvastatin orders entered for patients also receiving amiodarone. An appropriate order was defined as an order for simvastatin of ≤20 mg/day for the original alert and ≤10 mg/day for the revised alert. The dosage limits for simvastatin were different for the original and the revised alerts because, in June 2011, FDA changed the maximum recommended dosage of simvastatin when
Am J Health-Syst Pharm—Vol 70 Nov 1, 2013
coprescribed with amiodarone to 10 mg daily.6 Although FDA subsequently changed the maximum recommended dosage of simvastatin back to 20 mg daily when coprescribed with amiodarone in October 2011, 10 mg daily was the FDArecommended dosage during our intervention period. The rates of musclerelated adverse effects, including muscle pain, myopathy, and rhabdomyolysis, were also evaluated. Student’s t test was used to compare continuous variables. Categorical variables were analyzed using Fisher’s exact test. The a priori level of significance was 0.05. Baseline characteristics were similar between groups, except for ventricular arrhythmia, which was more common in the control group (58% versus 18%, p < 0.001). Simvastatin orders were appropriate for all 10 patients in the intervention group for whom simvastatin and amiodarone were coprescribed, compared with 9 (56%) of 16 patients in the control group (p = 0.02). Among the 44% of inappropriate simvastatin orders in the control group, 43% were subsequently changed to an appropriate order during the patients’ hospitalization. One hundred percent of orders in the intervention group for any statin coad-
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
