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355. Value-Based Medicine: Dollars and Sense.

Author

Erstad, Brian L.

Subjects
*MEDICAL care costs, *MEDICAL fees, *PUBLIC health, *PATIENT satisfaction, *PHARMACEUTICAL industry, *MANAGEMENT
Abstract

With ever-increasing total healthcare expenditures and expenditures on new pharmaceuticals, there is a temptation to enact relatively simple silo-based, cost-control measures such as attempts to control a burgeoning health-system medication budget by limiting physician and ultimately patient access to medications without considering cost-effectiveness or overall value. Such an approach with a singular focus on dollars does not make sense. The challenge is to think beyond a pure dollars approach in a specialty of health care where the high cost of care is acknowledged but the dynamics are not always understood. This will take a thoughtful, coordinated effort by a team of dedicated health professionals that includes a clinical pharmacist with expertise in optimal and comprehensive medication management. [ABSTRACT FROM AUTHOR]

Published
2016
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356. Readmissions related to antihypertensive medications used in chronic hemodialysis.

Author

Honkonen, Marcella N., McNeill, Patrick, Jasensky, Alex, and Erstad, Brian L.

Subjects
ANTIHYPERTENSIVE agents, PATIENT readmissions, HEMODIALYSIS, CONGESTIVE heart failure, HYPERTENSION
Abstract

Background: In hemodialysis, hypertension is treated by removing excess fluid and antihypertensive therapy. Commonly, the antihypertensives used to treat hypertension in earlier stages of kidney disease are continued as the patient progresses into end-stage renal disease and begins dialysis, without much evidence for benefit.Methods: This study is a single center, retrospective chart review that included hemodialysis patients admitted for congestive heart failure (CHF), fluid overload, or pulmonary edema as determined by ICD-9 code (428.x, 276.6, 518.4, 506.1). The primary objective was to determine if the number or class of antihypertensives used in the chronic hemodialysis population increased the number of readmissions related to CHF, fluid overload, or pulmonary edema. Patients were separated into two groups based on total number of antihypertensive medications, less than or equal to 2 medications for group 1 and greater than two medications for group 2. The primary endpoint was 30-day readmission for CHF, fluid overload, or pulmonary edema.Results: For the study period, 85 individual patient charts met inclusion criteria. Group 1 (n = 44) experienced seven readmissions (16%) and group 2 (n = 41) experienced eight readmissions (18%) (p = 0.663). The most common antihypertensives at discharge were ACE inhibitors for group 1 (45%) and dihydropyridine calcium channel blockers for group 2 (66%). No difference in systolic blood pressures before, during and after hemodialysis was found between groups.Conclusions: Antihypertensive medications continue to play an important role in the hemodialysis population. This study suggests that drug class and quantity of antihypertensives do not alter readmission rate in the setting of fluid overload. [ABSTRACT FROM AUTHOR]

Published
2016
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357. 61

Author

McKinney, Courtney, primary, Patanwala, Asad, additional, Sakles, John, additional, and Erstad, Brian, additional

Published
2012
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359. Infection risk and management strategies for patients with cirrhosis taking proton pump inhibitors.

Author

Zerr, Beth, Vazquez, Alejandro, and Erstad, Brian L

Subjects
*INFECTION risk factors, *COMMUNICABLE diseases, *PERITONITIS, *FIBROSIS, *GASTROINTESTINAL diseases, *PROTON pump inhibitors, *LIVER diseases, *MANAGEMENT, *ADVERSE health care events
Abstract

Purpose The purpose of this review is to discuss infectious disease–related adverse effects associated with long-term proton pump inhibitor (PPI) therapy in patients with cirrhosis and to provide recommendations for appropriate use and choice of PPI when such therapy is indicated. Summary Long-term PPI therapy in patients with cirrhosis increases the risk of infections, with infections in turn increasing the risk of mortality in this patient population. Expert recommendations include restricting long-term PPI use in cirrhosis to patients with appropriate gastrointestinal indications, using a PPI for the shortest possible duration and at the lowest possible dose, and avoiding PPIs with unfavorable pharmacogenetic properties. Conclusion Long-term PPI use in patients with cirrhosis has been associated with increased infections. The risk of adverse effects in observational studies, including decompensation, severe infection (especially spontaneous bacterial peritonitis), and increased mortality, appears to increase as the dose and duration of PPI increase. [ABSTRACT FROM AUTHOR]

Published
2023
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373. Structured Approaches to Pain Management in the ICU

Author

Pasero, Chris, primary, Puntillo, Kathleen, additional, Li, Denise, additional, Mularski, Richard A., additional, Grap, Mary Jo, additional, Erstad, Brian L., additional, Varkey, Basil, additional, Gilbert, Hugh C., additional, Medina, Justine, additional, and Sessler, Curtis N., additional

Published
2009
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375. Evaluation of Pain in ICU Patients

Author

Puntillo, Kathleen, primary, Pasero, Chris, additional, Li, Denise, additional, Mularski, Richard A., additional, Grap, Mary Jo, additional, Erstad, Brian L., additional, Varkey, Basil, additional, Gilbert, Hugh C., additional, Medina, Justine, additional, and Sessler, Curtis N., additional

Published
2009
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376. Pain Management Principles in the Critically Ill

Author

Erstad, Brian L., primary, Puntillo, Kathleen, additional, Gilbert, Hugh C., additional, Grap, Mary Jo, additional, Li, Denise, additional, Medina, Justine, additional, Mularski, Richard A., additional, Pasero, Chris, additional, Varkey, Basil, additional, and Sessler, Curtis N., additional

Published
2009
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393. ASHP guidelines on documenting pharmaceutical care in patient medical records

Author

Hammond, Raymond W., primary, Boyce, Bill, additional, Briceland, Laurie, additional, Canaday, Bruce, additional, Carr-Lopez, Sian M., additional, Eggleston, Steven T., additional, Erstad, Brian, additional, Gordon, Wendy L., additional, Herrier, Richard N., additional, Hudson, Teresa J., additional, Lau, Anna, additional, Malyuk, Doug, additional, Matuschka, Paul, additional, Mohassel, Maryam R., additional, Mutnick, Alan H., additional, Nelson, Bruce, additional, Rich, Darryl, additional, Sellers, Jill A., additional, Shane, Rita R., additional, Shepherd, Michele F., additional, Schumock, Glen T., additional, Umhoefer, Sherry, additional, and Yan, Jun, additional

Published
2003
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394. Navigating the Path to Careers in Academic Pharmacy Administration

Author

Erstad, Brian L., Youmans, Sharon L., and Crismon, M. Lynn

Abstract

The purpose of this commentary is to discuss the qualifications, responsibilities, and keys to success for pharmacy faculty considering a department (or division) chair (head) or dean (including assistant or associate dean) position. The perspectives are those of a department chair, vice dean, and past dean of colleges of pharmacy with extensive experience in pharmacy administration. The qualifications for these administrative positions vary by institution, particularly with respect to the institution’s focus on research. Because the dean is the chief executive officer of a college of pharmacy, previous administrative experience is almost always a basic requirement for the position. For associate/assistant deans and department chairs, previous experience as a faculty member is a typical minimum requirement and may include experience as a department vice chair or director of a unit within the department or division. The dean has a fiduciary duty to university administration, as well as to other external and internal stakeholders, to educate and graduate competent pharmacists and to operate within budget. Associate/assistant deans often have responsibility for specific functions of the college, such as student or professional affairs, and it is common for deans to delegate authority, responsibility, and accountability to associate/assistant deans. Department chairs have a unique perspective with respect to college activities because they must not only think about the “big picture” when considering issues with other college administrators but must oversee the implementation and monitoring of strategic initiatives through the faculty and staff who report to them.

Published
2023
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395. Management of Critically Ill Patients Receiving Medications for Opioid Use Disorder

Author

Erstad, Brian L. and Glenn, Melody J.

Abstract

Critical care clinicians are likely to see an increasing number of patients admitted to the ICU who are receiving Food and Drug Administration-approved medications for opioid use disorder (MOUDs) given the well-documented benefits of these agents. Oral methadone, multiple formulations of buprenorphine, and extended-release naltrexone are the three types of MOUD most likely to be encountered by ICU clinicians; however, these drugs vary with respect to formulations, pharmacokinetics, and adverse effects.

Published
2023
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396. Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS

Author

Train, Sarah E., Burns, Karen E.A., Erstad, Brian L., Massaro, Anthony, Wu, Ting Ting, Vassaur, John, Selvan, Kavitha, Kress, John P., and Devlin, John W.

Abstract

The perceptions and practices of ICU physicians regarding initiating neuromuscular blocker infusions (NMBI) in acute respiratory distress syndrome (ARDS) may not be evidence-based amidst the surge of severe ARDS during the SARS-CoV-2 pandemic and new practice guidelines. We identified ICU physicians' perspectives and practices regarding NMBI use in adults with moderate-severe ARDS.

Published
2022
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400. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient

Author

Murray, Michael J., primary, Cowen, Jay, additional, DeBlock, Heidi, additional, Erstad, Brian, additional, Gray, Anthony W., additional, Tescher, Ann N., additional, McGee, William T., additional, Prielipp, Richard C., additional, Susla, Greg, additional, Jacobi, Judith, additional, Nasraway, Stanley A., additional, and Lumb, Philip D., additional

Published
2002
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