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20. Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

Author

Tan, Xi, Marshall, Vincent D., and Balkrishnan, Rajesh

Abstract

Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan® Multi-State Medicaid Database 2003-2007 data. A total of 3,905 eligible community-based Medicaid enrollees aged 18-64 with dual diagnosis of developmental disability and mental illness were included and followed over an average of 510 days. Medication adherence was measured by Proportion of Days Covered (PDC), and logistic regression was used to assess factors associated with adherence. The mean PDC was 0.86, and the non-adherence rate was 25.7%. Factors associated with poor psychotropic medication adherence included minority race/ethnicity, female gender, enrollment in a Medicaid capitated plan, and having gastroesophageal reflux disease (GERD). Better psychotropic medication adherence was related to reductions in emergency room visits, suggesting better utilization outcomes.

Published
2015
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32. Evaluating the Impact of CYP3A5 Genotype on Post-Transplant Healthcare Resource Utilization in Pediatric Renal and Heart Transplant Recipients Receiving Tacrolimus

Author

Pasternak,Amy L, Marshall,Vincent D, Gersch,Christina L, Rae,James M, Englesbe,Michael, Park,Jeong M, Pasternak,Amy L, Marshall,Vincent D, Gersch,Christina L, Rae,James M, Englesbe,Michael, and Park,Jeong M

Abstract

Amy L Pasternak,1 Vincent D Marshall,1 Christina L Gersch,2 James M Rae,2 Michael Englesbe,3 Jeong M Park1 1Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, 48109, USA; 2Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, 48109, USA; 3Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USACorrespondence: Amy L Pasternak Email amylp@med.umich.eduPurpose: CYP3A5 genotype is a significant contributor to inter-individual tacrolimus exposure and may impact the time required to achieve therapeutic concentrations and number of tacrolimus dose adjustments in transplant patients. Increased modifications to tacrolimus therapy may indicate a higher burden on healthcare resources. The purpose of this study was to evaluate whether CYP3A5 genotype was predictive of healthcare resource utilization in pediatric renal and heart transplant recipients.Patients and Methods: Patients < 18 years of age with a renal or heart transplant between 6/1/2014– 12/31/2018 and tacrolimus-based immunosuppression were included. Secondary use samples were obtained for CYP3A5 genotyping. Clinical data was retrospectively collected from the electronic medical record. Healthcare resource utilization measures included the number of dose changes, number of tacrolimus concentrations, length of stay, number of clinical encounters, and total charges within the first year post-transplant. Rejection and donor-specific antibody (DSA) formation within the first year were also collected. The impact of CYP3A5 genotype was evaluated via univariate analysis for the first year and multivariable analysis at 30, 90, 180, 270, and 365 days post-transplant.Results: Eighty-five subjects were included, 48 renal transplant recipients and 37 heart transplant recipients. CYP3A5 genotype was not associated with any outcomes in renal transplant, however, a CYP3A5 expresser phenotype was a predictor of more dose changes, more tacrolimus concen

Published
2021

37. Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficile and gastrointestinal panel testing

Author

Tran, Nikki N., primary, Mills, John P., additional, Zimmerman, Christopher, additional, Gandhi, Tejal N., additional, Tribble, Alison C., additional, Petty, Lindsay A., additional, Nagel, Jerod, additional, Brancaccio, Adamo, additional, Scappaticci, Gianni, additional, Patel, Twisha, additional, Dillman, Nicholas O., additional, Regal, Randolph, additional, Klein, Kristin C., additional, Washer, Laraine, additional, Marshall, Vincent D., additional, Sweeney, Jennifer, additional, Rao, Krishna, additional, and Eschenauer, Gregory A., additional

Published
2020
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45. The impact of drug order complexity on prospective medication order review and verification time.

Author

Dakwa, David S, Marshall, Vincent D, and Chaffee, Bruce W

Abstract

Objective: To assess if the amount of time a pharmacist spends verifying medication orders increases as medication orders become more complex.Materials and Methods: The study was conducted by observing pharmacist verification of adult medication orders in an academic medical center. Drug order complexity was prospectively defined and validated using a classification system derived from 3 factors: the degree of order variability, ISMP high-alert classification, and a pharmacist perception survey. Screen capture software was used to measure pharmacist order review time for each classification. The annualized volume of low complexity drug orders was used to calculate the potential time savings if these were verified using an alternate system that did not require pharmacist review.Results: The primary study hypothesis was not achieved. Regression results did not show statistical significance for moderate (n = 30, 23.7 seconds, sd = 23.3) or high complexity (n = 30, 18.6 seconds, sd = 23.1) drugs relative to the low complexity drugs (n = 30, 8.0 seconds, sd = 14.4) nor for moderate vs high complexity; (βmoderate vs low = 15.6, P = .113), (βhigh vs low = 10.3, P = .235), (βmoderate vs high = 5.3, P = .737). The sensitivity analysis showed statistical significance in the high vs low comparison (βhigh vs low = 13.8, P = .017).Discussion: This study showed that verifying pharmacists spent less time than projected to verify medication orders of different complexities, but the time did not correlate with the classifications used in our complexity scale. Several mitigating factors, including operational aspects associated with timing antimicrobial orders, likely influenced order verification time. These factors should be evaluated in future studies which seek to define drug order complexity and optimize pharmacist time spent in medication order verification.Conclusion: The findings suggest that there may be other factors involved in pharmacist decision-making that should be considered when categorizing drugs by perceived complexity. [ABSTRACT FROM AUTHOR]

Published
2020
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47. A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia

Author

Foolad, Farnaz, primary, Huang, Angela M, additional, Nguyen, Cynthia T, additional, Colyer, Lindsay, additional, Lim, Megan, additional, Grieger, Jessica, additional, Li, Julius, additional, Revolinski, Sara, additional, Mack, Megan, additional, Gandhi, Tejal, additional, Wainaina, J Njeri, additional, Eschenauer, Gregory, additional, Patel, Twisha S, additional, Marshall, Vincent D, additional, and Nagel, Jerod, additional

Published
2018
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48. Reply

Author

Parikh, Neehar D., primary, Singal, Amit G., additional, Lok, Anna S., additional, Balkrishnan, Rajesh, additional, Shahinian, Vahakn, additional, and Marshall, Vincent D., additional

Published
2017
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49. A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)

Author

Boyd, Anthony M, primary, Nagel, Jerod, additional, Eschenauer, Gregory, additional, Marshall, Vincent D, additional, Gandhi, Tejal, additional, Chenoweth, Carol, additional, Petty, Lindsay, additional, McClung, Daniel, additional, and Patel, Twisha S, additional

Published
2017
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50. Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficileand gastrointestinal panel testing

Author

Tran, Nikki N., Mills, John P., Zimmerman, Christopher, Gandhi, Tejal N., Tribble, Alison C., Petty, Lindsay A., Nagel, Jerod, Brancaccio, Adamo, Scappaticci, Gianni, Patel, Twisha, Dillman, Nicholas O., Regal, Randolph, Klein, Kristin C., Washer, Laraine, Marshall, Vincent D., Sweeney, Jennifer, Rao, Krishna, and Eschenauer, Gregory A.

Abstract

AbstractObjective:To evaluate whether incorporating mandatory prior authorization for Clostridioides difficiletesting into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.Design:Single center, quasi-experimental before-and-after study.Setting:Tertiary-care, academic medical center in Ann Arbor, Michigan.Patients:Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficileenzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.Intervention:A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.Results:An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56–0.93; P= .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37–0.77; P= .001), respectively.Conclusions:We identified an efficient, effective C. difficileand GIPAN diagnostic stewardship approval model.

Published
2020
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