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Development, implementation and cost-effectiveness of a protocol for review of combination diuretic prescribing
Julie D Morgan1, David J Wright, Henry Chrystyn
1School of Pharmacy, University of Bradford, Bradford, UK. j.d.morgan@bradford.ac.uk
Insights
Nearly 60% of prescribed potassium-sparing diuretics (PSDs) were unnecessary. Implementing a protocol for diuretic prescribing can enhance patient safety and reduce healthcare costs.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Pharmacoeconomics
Background:
- Inappropriate prescribing of combination diuretics, particularly potassium-sparing diuretics (PSDs), poses risks to patient safety.
- Evaluating the extent of unnecessary PSD prescriptions is crucial for optimizing pharmacotherapy in elderly patients.
Purpose of the Study:
- To assess the prevalence of inappropriate prescribing of combination diuretics.
- To determine the cost implications associated with implementing a protocol for diuretic use.
Main Methods:
- A pharmacist-led medication review was conducted in two UK general practices.
- A protocol was developed and applied to identify patients on unnecessary potassium-sparing diuretics.
Main Results:
- Sixty-one elderly patients (mean age 75.8 years) were reviewed.
- Discontinuation of PSDs in 30 patients (49.2%) led to a significant reduction in serum potassium levels.
- 93.3% of patients who had PSDs discontinued were within the normal potassium reference range at follow-up.
Conclusions:
- Over half (59%) of prescribed PSDs were identified as unnecessary.
- The developed protocol shows potential for improving drug safety and achieving cost savings in diuretic management.
Aims:
To determine the extent of inappropriate prescribing of combination diuretics and the cost implications of protocol implementation.
Methods:
Pharmacist-run medication review clinics in two general practices in Bradford, UK.
Results:
Sixty-one patients, mean +/- s.d. age 75.8 +/- 12.0 years, were reviewed. Thirty-six met protocol criteria; 30 (49.2%) patients had their potassium-sparing diuretics (PSDs) discontinued. Mean (95% confidence interval) reduction in serum potassium concentrations after intervention in these 30 patients was 0.26 (0.09, 0.43) mmol l(-1) (P < 0.01). Twenty-eight (93.3%) patients were within the reference range at follow-up; none was below.
Conclusions:
Of prescribed PSDs, 59% were found to be unnecessary. Using the developed protocol potentially improves drug safety and enables cost savings.