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Cetirizine Switch to Over-the Counter: Patient Response and Impact on Treatment Compliance
128
Using Electronic Health Record as a Tool to Assess Adherence to Clinical Practice Parameters for Allergic Rhinitis M. W. Shepherd, J. B. Wallis; LSU Health Sciences Center, New Orleans, LA. RATIONALE: Intranasal corticosteroids are the most effective therapy for allergic rhinitis according to the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology. The federally mandated electronic health record (EHR) is a useful tool to assess adherence to clinical practice guidelines. We used analysis of the EHR to evaluate how often a primary care clinic prescribes intranasal corticosteroids in patients with allergic rhinitis compared to an allergy clinic as well as the prevalence of nasal steroid use in adult versus pediatric patients. METHODS: Using the Allscripts EHR Analytics program, we pulled 556 patients with a diagnosis of Allergic Rhinitis (ICD-9 codes 477.x) from the LSU MedPeds clinic and LSU Allergy clinic who both use the Allscripts Enterprise EHR for patient visits. We then identified patients who were prescribed a nasal steroid. We placed these lists in Excel 2007 and used pivots tables to analyze the data and create charts. Chi square tests were used to evaluate statistical significance (alpha 5 0.05) in SASv9.13. RESULTS: The Allergy versus MedPeds clinic difference in use of nasal steroids was 62.2% versus 47.8% which was statistically significant (p 5 0.06). The difference in prescription rates between the pediatric and adult populations in the MedPeds clinic was not statistically significant (p 5 0.14). CONCLUSIONS: We found that within the primary care clinic, intranasal corticosteroids are prescribed less often for allergic rhinitis than in an allergy clinic. We hypothesize that dissemination of these findings to practicing primary care physicians might help them to better follow established guidelines of patient care for allergic rhinitis patients.
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Electronic Immunotherapy Record System (EIRS) is Efficient and Safe Compared to a Paper-Based System (PBS) in a Multi-centered Single Specialty Private Allergy Practice A. D. Adinoff1, N. P. Joshi2, J. Milewski3; 1U of Colorado Health Sciences Center, Denver, CO, 2none, none, CO, 3University of Denver, Denver, CO. RATIONALE: CAAC has 10 Denver metropolitan area offices, administering approximately 88,000 IT annually. In 2009, CAAC moved to Meditab’s EIRS, which allows computerized patient/procedure tracking. A cost-benefit analysis (CBA) of EIRS compared with PBS was performed. We also asked the questions whether this system was accepted by staff. METHODS: Data were collected from January-April. EIRS was implemented at 5 offices by April, and compared with the 5 offices that remained on PBS during that same time. To perform a CBA, we determined the return on investment (ROI) of the EIRS (hardware, software, maintenance, supplies, training, labor) compared to the PBS. An employee opinion survey (EOP) was conducted. RESULTS: During the study period approximately 30,000 IT were given. The average time for IT was 150 seconds (SD 6 21.8) for the EIRS and 180 (SD 6 5.6) for the PBS (p < 0.001). The total cost for implementation of EIRS was calculated to be $130,000 for all 10 offices; the benefit from saved labor and supplies was calculated to be $65,734 each year. EOP showed 81% of staff preferred EIRS, felt it was more efficient than PBS, and easy to use. CONCLUSION: EIRS improves the documentation and speed of IT by eliminating redundant steps of PBS. It is cost efficient: the ROI is less than 3 years. There was measurable positive acceptance by staff, which was able to learn and incorporate the system quickly. Because EIRS tracks errors and generates reports electronically, it easily works towards reducing errors, thus improving patient safety.
130
Epipen Demographics and Use in a V.A. Population A. Amirzadeh, W. Klaustermeyer; VA Greater Los Angeles, Los Angeles, CA. RATIONALE: Epinephrine auto injector (Epi-pen) use and demographic data have not been studied in a VA population. This study investigates utilization and patient’s understanding of Epi-pen use in this population. METHODS: We conducted a survey of 66 patients who were prescribed Epi-pen and followed in the Allergy and Immunology Clinics at the West Los Angeles Veterans Hospital from January to July 2009. Data analyzed included patient demographics, medical indication for Epi-pen prescription, and patient’s understanding of the need for Epi-pen. Additional data was obtained retrospectively from the computerized medical records. RESULTS: The mean age of our patients was 50 years. There were 44 men (66.7%) and 22 women (33%). Twenty three (23) patients were prescribed Epi-pen for food reactions. Ninety two percent (92%) of the patients knew how to use their Epi-pen properly, however, only 58% carried their Epi-pen with them consistently. Of the patients, 91% understood why the Epi-pen was prescribed. Of the total patients prescribed Epi-pen, 79% refilled their medication before the one year expiration date. Only 12% of the patients studied had required the use of their Epi-pen. CONCLUSIONS: Most patients knew how and when to administer their Epi-pen. Yet only a slight majority stated that they carried it consistently. Despite instruction in a specialty clinic, this data clearly indicates that further patient education or other measures are needed to improve compliance.
131
Cetirizine Switch to Over-the Counter: Patient Response and Impact on Treatment Compliance E. Urdaneta1, C. L. Lin2, C. R. Pollack2, B. Zimmerman1, M. Wu3, S. Furey4, E. K. Kuffner1; 1McNeil Consumer Healthcare, Fort Washington, PA, 2Consultant, Fort Washington, PA, 3Johnson & Johnson Consumer Products Worldwide, Morris Plains, MO, 4Johnson & Johnson Consumer Products Worldwide, Morris Plains, NJ. RATIONALE: The January 2008 switch of cetirizine from prescription to over-the-counter (OTC) availability provides allergy sufferers with a costeffective and accessible alternative to prescription H1-receptor antagonists with similar efficacy. To better understand how the switch of cetirizine to OTC status affected allergy sufferers, patients were queried about their treatment decisions. METHODS: Data regarding prescription and OTC antihistamine use, patientsÕ reasons for use of specific products, and their satisfaction with symptom responses were collected from diaries that were completed by approximately 800 households and over 5100 patient surveys during the first year of OTC availability. PatientsÕ personal decisions regarding allergy management and OTC cetirizine use were summarized. RESULTS: Following the switch of cetirizine from prescription to OTC status, patients and healthcare professionals opted for OTC cetirizine rather than prescription antihistamines as demonstrated by a 27.7% reduction in the number of antihistamine prescriptions filled. Patient-reported reasons for using OTC cetirizine included: strong efficacy profile, previous availability as prescription drug, brand loyalty, and acknowledgment of specialistsÕ recommendations of cetirizine. Among branded OTC antihistamines, on average, patients reported using cetirizine 116 days annually and loratadine or diphenhydramine 78 days each annually. Patients reported a high degree of satisfaction with symptom relief with OTC cetirizine (28%) compared to OTC loratadine (18%), diphenhydramine (14%), or other antihistamines (15%). CONCLUSIONS: Since switching from prescription to OTC status, cetirizine is highly accepted and used by allergy sufferers. Likely the combination of patient-proven effectiveness, ease of accessibility, and allergistsÕ recommendations influence patients to use OTC cetirizine for effective management of their allergy symptoms.
SATURDAY
Abstracts AB33
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
Using Electronic Health Record as a Tool to Assess Adherence to Clinical Practice Parameters for Allergic Rhinitis M. W. Shepherd, J. B. Wallis; LSU Health Sciences Center, New Orleans, LA. RATIONALE: Intranasal corticosteroids are the most effective therapy for allergic rhinitis according to the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology. The federally mandated electronic health record (EHR) is a useful tool to assess adherence to clinical practice guidelines. We used analysis of the EHR to evaluate how often a primary care clinic prescribes intranasal corticosteroids in patients with allergic rhinitis compared to an allergy clinic as well as the prevalence of nasal steroid use in adult versus pediatric patients. METHODS: Using the Allscripts EHR Analytics program, we pulled 556 patients with a diagnosis of Allergic Rhinitis (ICD-9 codes 477.x) from the LSU MedPeds clinic and LSU Allergy clinic who both use the Allscripts Enterprise EHR for patient visits. We then identified patients who were prescribed a nasal steroid. We placed these lists in Excel 2007 and used pivots tables to analyze the data and create charts. Chi square tests were used to evaluate statistical significance (alpha 5 0.05) in SASv9.13. RESULTS: The Allergy versus MedPeds clinic difference in use of nasal steroids was 62.2% versus 47.8% which was statistically significant (p 5 0.06). The difference in prescription rates between the pediatric and adult populations in the MedPeds clinic was not statistically significant (p 5 0.14). CONCLUSIONS: We found that within the primary care clinic, intranasal corticosteroids are prescribed less often for allergic rhinitis than in an allergy clinic. We hypothesize that dissemination of these findings to practicing primary care physicians might help them to better follow established guidelines of patient care for allergic rhinitis patients.
129
Electronic Immunotherapy Record System (EIRS) is Efficient and Safe Compared to a Paper-Based System (PBS) in a Multi-centered Single Specialty Private Allergy Practice A. D. Adinoff1, N. P. Joshi2, J. Milewski3; 1U of Colorado Health Sciences Center, Denver, CO, 2none, none, CO, 3University of Denver, Denver, CO. RATIONALE: CAAC has 10 Denver metropolitan area offices, administering approximately 88,000 IT annually. In 2009, CAAC moved to Meditab’s EIRS, which allows computerized patient/procedure tracking. A cost-benefit analysis (CBA) of EIRS compared with PBS was performed. We also asked the questions whether this system was accepted by staff. METHODS: Data were collected from January-April. EIRS was implemented at 5 offices by April, and compared with the 5 offices that remained on PBS during that same time. To perform a CBA, we determined the return on investment (ROI) of the EIRS (hardware, software, maintenance, supplies, training, labor) compared to the PBS. An employee opinion survey (EOP) was conducted. RESULTS: During the study period approximately 30,000 IT were given. The average time for IT was 150 seconds (SD 6 21.8) for the EIRS and 180 (SD 6 5.6) for the PBS (p < 0.001). The total cost for implementation of EIRS was calculated to be $130,000 for all 10 offices; the benefit from saved labor and supplies was calculated to be $65,734 each year. EOP showed 81% of staff preferred EIRS, felt it was more efficient than PBS, and easy to use. CONCLUSION: EIRS improves the documentation and speed of IT by eliminating redundant steps of PBS. It is cost efficient: the ROI is less than 3 years. There was measurable positive acceptance by staff, which was able to learn and incorporate the system quickly. Because EIRS tracks errors and generates reports electronically, it easily works towards reducing errors, thus improving patient safety.
130
Epipen Demographics and Use in a V.A. Population A. Amirzadeh, W. Klaustermeyer; VA Greater Los Angeles, Los Angeles, CA. RATIONALE: Epinephrine auto injector (Epi-pen) use and demographic data have not been studied in a VA population. This study investigates utilization and patient’s understanding of Epi-pen use in this population. METHODS: We conducted a survey of 66 patients who were prescribed Epi-pen and followed in the Allergy and Immunology Clinics at the West Los Angeles Veterans Hospital from January to July 2009. Data analyzed included patient demographics, medical indication for Epi-pen prescription, and patient’s understanding of the need for Epi-pen. Additional data was obtained retrospectively from the computerized medical records. RESULTS: The mean age of our patients was 50 years. There were 44 men (66.7%) and 22 women (33%). Twenty three (23) patients were prescribed Epi-pen for food reactions. Ninety two percent (92%) of the patients knew how to use their Epi-pen properly, however, only 58% carried their Epi-pen with them consistently. Of the patients, 91% understood why the Epi-pen was prescribed. Of the total patients prescribed Epi-pen, 79% refilled their medication before the one year expiration date. Only 12% of the patients studied had required the use of their Epi-pen. CONCLUSIONS: Most patients knew how and when to administer their Epi-pen. Yet only a slight majority stated that they carried it consistently. Despite instruction in a specialty clinic, this data clearly indicates that further patient education or other measures are needed to improve compliance.
131
Cetirizine Switch to Over-the Counter: Patient Response and Impact on Treatment Compliance E. Urdaneta1, C. L. Lin2, C. R. Pollack2, B. Zimmerman1, M. Wu3, S. Furey4, E. K. Kuffner1; 1McNeil Consumer Healthcare, Fort Washington, PA, 2Consultant, Fort Washington, PA, 3Johnson & Johnson Consumer Products Worldwide, Morris Plains, MO, 4Johnson & Johnson Consumer Products Worldwide, Morris Plains, NJ. RATIONALE: The January 2008 switch of cetirizine from prescription to over-the-counter (OTC) availability provides allergy sufferers with a costeffective and accessible alternative to prescription H1-receptor antagonists with similar efficacy. To better understand how the switch of cetirizine to OTC status affected allergy sufferers, patients were queried about their treatment decisions. METHODS: Data regarding prescription and OTC antihistamine use, patientsÕ reasons for use of specific products, and their satisfaction with symptom responses were collected from diaries that were completed by approximately 800 households and over 5100 patient surveys during the first year of OTC availability. PatientsÕ personal decisions regarding allergy management and OTC cetirizine use were summarized. RESULTS: Following the switch of cetirizine from prescription to OTC status, patients and healthcare professionals opted for OTC cetirizine rather than prescription antihistamines as demonstrated by a 27.7% reduction in the number of antihistamine prescriptions filled. Patient-reported reasons for using OTC cetirizine included: strong efficacy profile, previous availability as prescription drug, brand loyalty, and acknowledgment of specialistsÕ recommendations of cetirizine. Among branded OTC antihistamines, on average, patients reported using cetirizine 116 days annually and loratadine or diphenhydramine 78 days each annually. Patients reported a high degree of satisfaction with symptom relief with OTC cetirizine (28%) compared to OTC loratadine (18%), diphenhydramine (14%), or other antihistamines (15%). CONCLUSIONS: Since switching from prescription to OTC status, cetirizine is highly accepted and used by allergy sufferers. Likely the combination of patient-proven effectiveness, ease of accessibility, and allergistsÕ recommendations influence patients to use OTC cetirizine for effective management of their allergy symptoms.
SATURDAY
Abstracts AB33
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2