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Interventions to Increase Leukocyte Testing During Treatment with Dimethyl Fumarate

International journal of environmental research and public health(2021)SCI 3区

Vet Affairs Palo Alto Hlth Care Syst | Medicat Safety Pharm Benefits Management Serv | Vet Affairs VA Pharm Benefits Management Serv

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Abstract
Dimethyl fumarate (DMF), a treatment for multiple sclerosis, may cause leukopenia and infection. Accordingly, periodic white blood cell (WBC) monitoring is recommended. We sought to evaluate the US Department of Veteran Affairs’ safety program which provides facilities with a list of patients prescribed DMF therapy without a documented white blood cell count (WBC). We identified 118 sites with patients treated with DMF from 1 January 2016 through 30 September 2016. Each site was asked if any of seven interventions were used to improve WBC monitoring (academic detailing, provider education without academic detailing, electronic clinical reminders, request for provider action plan, draft orders for WBC monitoring, patient mailings, and patient calls). The survey response rate was 78%. For the 92 responding sites (78%) included sites (1115 patients) the mean rate of WBC monitoring was 54%. In multivariate analysis, academic detailing increased the rate by 17% (95% CI 4 to 30%, p = 0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, p = 0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2–6.4%, p = 0.005). Interventions focused on the physician, including academic detailing, were associated with improved WBC monitoring for patients at risk for leukopenia from DMF treatment.
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outcome assessment,health care,clinical pharmacy information systems,pharmacy services,multiple sclerosis,psoriasis,United States Department of Veterans Affairs
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要点】:研究评估了美国退伍军人事务部安全项目采用的七种干预措施对提高使用二甲枫酸治疗多发性硬化患者的白细胞计数监测率的效果,发现学术详细说明和提供者教育能有效提升监测率。

方法】:通过调查问卷收集了118个治疗点在2016年1月1日至2016年9月30日期间使用二甲枫酸治疗患者的白细胞计数监测情况,并分析了七种不同干预措施的实施与监测率之间的关系。

实验】:对92个响应的调查点(占78%)包含的1115名患者进行分析,结果显示采用学术详细说明和提供者教育的站点白细胞计数监测率分别提高了17%和9%,并且每增加一种干预措施,监测率平均提高3.8%。