Unnecessary lipid-lowering drugs in an outpatient geriatric clinic

Identify the number of patients in the University of Colorado Seniors Clinic who were prescribed a nonstatin lipid-lowering therapy and describe a pharmacist intervention that can reduce the unnecessary use of these agents.

Outpatient geriatrics clinic in a university health system.

The University of Colorado Seniors Clinic provides outpatient care for ambulatory patients 75 years of age or older. In 2012, there were 2,000 active patients, with 7,000 clinic visits.

All patients prescribed extended-release niacin, ezetimibe, fenofibrate, gemfibrozil, or prescription omega-3-acid ethyl esters were identified. Extended-release niacin, ezetimibe, fenofibrate, and gemfibrozil were deemed necessary if the patient was intolerant to statin therapy or could not attain the cholesterol goal with the maximum tolerated dose of a statin. Fenofibrate, gemfibrozil, and prescription omega-3-acid ethyl esters were considered necessary if the patient had a history of triglycerides above 500 mg/dL. If a pharmacist deemed the medication unnecessary, a note was placed in the medical record and discussed face-to-face with the provider.

The number of patients and types of drugs that were prescribed and discontinued; the cost savings to the health system.

Fifty-five patients were prescribed a potentially unnecessary lipid-lowering drug. Twenty-three drugs were discontinued, for an estimated $38,660.40 in cost savings.

A low percentage of patients were prescribed a nonstatin lipid-lowering agent in this population. However, more than half were deemed unnecessary and were stopped, resulting in significant savings and health benefits. Applying this on a larger scale could result in significant savings and improved health.