Includes bibliographical references.

An Evaluation of Pharmacist-Led Interventions for Inpatient HIV-Related Medication Errors -- Defining the Correlation Between Heroin Overdose and Length of Hospital Admissions -- Comparison of Fluoroquinolone Versus Non-Fluoroquinolone Therapy for Inpatient Treatment of Chronic Obstructive Pulmonary Disease Exacerbations -- Cost-Sharing Requirements for the Herpes Zoster Vaccine in Adults Aged 60+

[Article Title: An Evaluation of Pharmacist-Led Interventions for Inpatient HIV-Related Medication Errors / Mary Joyce B. Wingler, Kayla R. Stover, Katie E. Barber and Jamie L. Wagner, p. 235-242]

Abstract:

Background: Inpatient HIV-related medication errors occur in up to 86% of patients.

Objective: To evaluate the number of antiretroviral therapy (ART)- and opportunistic infection (OI)-related medication errors following the implementation of pharmacist-directed interventions.

Methods: This quasi-experiment assessed adult patients with HIV who received ART, OI prophylaxis, or both from December 1, 2014, to February 28, 2017 (pre-intervention) or December 1, 2017, to February 28, 2018 (post-intervention). Pre-intervention patients were assessed retrospectively; verbal and written education were provided (intervention); prospective audit and feedback was conducted for post-intervention patients. The primary outcome was rate of ART errors between groups. Secondary outcomes included rate of OI errors, time to resolution of ART and OI errors, types of errors, and rate of recommendation acceptance.

Results: Sixty-seven patients were included in each group. ART errors occurred in 44.8% and 32.8% (P = .156), respectively. OI prophylaxis errors occurred in 11.9% versus 9% (P = .572), respectively. Medication omission decreased significantly in the post-intervention group (31.3% vs 11.9%; P = .006). Pharmacist-based interventions increased in the post-intervention group (6.3% vs 52.9%; P = .001). No statistical difference was found in time to error resolution (72 vs 48 hours; P = .123), but errors resolved during admission significantly increased (50% vs 86.8%; P < .001). No difference was found in rate of intervention acceptance (100% vs 97%).

Conclusion and Relevance: ART and OI prophylaxis errors resolved a day faster in the pharmacist-led, post-intervention period, and there was a trend toward error reduction. Future interventions should target prescribing errors on admission using follow-up education and evaluation of medication reconciliation practices in HIV-infected patients.

https://doi.org/10.1177/8755122519856728

[Article Title: Defining the Correlation Between Heroin Overdose and Length of Hospital Admissions / Justin Reinert, Rachel Leis, Alison Paplaskas and Deborah Bakle-Carn, p. 243-250]

Abstract:

Background:: Heroin has had an overwhelming impact on public welfare and health resources. National surveillance data indicate a 25% increase in drug overdose deaths in Ohio between 2012 and 2017, ranking the state second in terms of drug overdose deaths associated with opioids.

Objective:: The primary objective of this evaluation was to determine the length of hospital stay in suspected or confirmed heroin overdose.

Methods:: This retrospective analysis evaluated adult patients presenting to the emergency department (ED) at Mercy Health St Vincent Medical Center with confirmed or suspected heroin overdose. Patient data were obtained from the International Classification of Diseases, 10th revision, code reports. The study site is a 462-bed academic medical center with a level 1 trauma designation located in downtown Toledo, OH.

Results:: One-hundred and one patients were included in this study: 49 presented to the ED and were subsequently admitted, while 52 were evaluated in the ED and discharged. No statistically significant differences in demographic data were identified. The average length of stay for admitted patients was 4.39 days (range = 0-22 days) with an average of 1.91days in the intensive care unit and 2.48 days on a general medicine floor. Higher average amounts of naloxone administered prior to presentation to the ED were found to predict an admission to the intensive care unit (6.48 mg vs 2.43 mg, P = .0208). The most frequent necessary interventions were central line placement (16/49, 32.7%) and mechanical ventilation (15/49, 30.6%). Seven patients (14.3%) experienced a cardiac arrest.

Conclusion:: Heroin overdoses continue to require emergent interventions and consume numerous health care resources. Investment in strategies for prevention of overdose and the subsequent utilization of resources is paramount in controlling the heroin epidemic in Ohio and nationally.

https://doi.org/10.1177/8755122519860081

[Article Title: Comparison of Fluoroquinolone Versus Non-Fluoroquinolone Therapy for Inpatient Treatment of Chronic Obstructive Pulmonary Disease Exacerbations / Kassandra Ramos, Bryan Allen, Chad Cannon, Kristal Cunningham and Calvin Tucker, p. 251-257]

Abstract:

Background: While antimicrobial use in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) is reserved for more severe cases, the current evidence available comparing fluoroquinolones (FQs) to other classes in the inpatient setting are lacking.

Objective: To compare the effectiveness of FQ therapy compared with non-FQs (NFQs) during acute COPD exacerbations in hospitalized patients.

Methods: In this single-centered institutional review board–approved retrospective chart review, participants were included if they were at least 18 years of age and hospitalized for an acute exacerbation of COPD. Patients were stratified into FQ or NFQ groups based on the initial antimicrobial regimen administered. The primary outcome was the clinical resolution rate after antimicrobial therapy. Secondary outcomes included length of hospital stay, duration of antimicrobial therapy, 30-day readmission rates, and Clostridioides difficile infection rates.

Results: A total of 375 patients were included (FQ = 201; NFQ = 174). The NFQ group had a higher rate of clinical resolution (84.5% vs 76.1%, P = .0435). In a multivariable regression analysis, the association between NFQ therapy and higher rates of clinical resolution remained significant (odds ratio = 2.31; 95% confidence interval = 1.3-4.10; P = .0043). The FQ group had a shorter length of stay (4 vs 5 days; P = .0022) and shorter inpatient antibiotic duration (4 vs 5 days; P = .0200). Rates of Clostridioides difficile infection and readmission were similar between groups.

Conclusions: NFQ therapy may provide a higher rate of clinical resolution while avoiding exposure to FQ therapy and known adverse effects associated with FQ use.

https://doi.org/10.1177/8755122519858999

[Article Title: Cost-Sharing Requirements for the Herpes Zoster Vaccine in Adults Aged 60+ / Casey R. Tak, Jaewhan Kim, Karen Gunning, Catherine M. Sherwin, Nancy A. Nickman and Joseph E. Biskupiak, p. 258-269]

Abstract:

Background: Rates of zoster vaccination in US adults aged 60+ were approximately 30.6% in 2015. Out-of-pocket cost-sharing has been identified as a major barrier to vaccination for patients. To date, herpes zoster vaccine cost-sharing requirements for adults aged 60 to 64 has not been described.

Objective: Compare the cost-sharing requirements for zoster vaccination in adults aged 60 to 64 and adults aged 65+.

Methods: A retrospective cohort design examined pharmacy claims for zoster vaccination from the Utah All Payer Claims Database for adults aged 60+. Descriptive statistics and a 2-part cost model compared cost-sharing requirements for adults aged 60 to 64 and adults 65+.

Results: Of the 30 293 zoster vaccine claims, 13 398 (45.8%) had no cost-sharing, 1716 (5.9%) had low cost-sharing (defined as $1 to less than $30), and 14 133 (48.3%) had high cost-sharing (defined as $30 or more). In the cost models, adults aged 65+ had higher odds of any cost-sharing (odds ratio = 39.86) and 29% higher cost-sharing as compared with adults aged 60 to 64.

Conclusions: Adults aged 60 to 64 encounter lower cost-sharing requirements than adults aged 65+. Providers should be cognizant of this dynamic and encourage zoster vaccination prior to the age of 65.

https://doi.org/10.1177/8755122519860074