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Inappropriate Use of Fibrate Therapy in a University-Based Primary Care Clinic Setting*
Abstracts
213
Table 4 Independent predictors associated with providers’ knowledge of treatment goal for non-HDL-C Variable Male gender Age of the provider (per 10-year increase) Years since finishing residency or fellowship training (as a continuous variable) Physician provider (nonphysician providers as referent) Specialty provider (primary care providers as referent) Academic affiliation* Number of outpatients seen daily (as a continuous variable) Percent of patients in a provider’s panel with diagnosis of dyslipidemia (as a continuous variable) Use of specialized lipid testing (no use or rare use as referent)
Odds ratio (95% confidence interval) 0.43 (0.17–1.10) 0.64 (0.33–1.24) 1.05 (0.98–1.13)
0.95 (0.34–2.67) 0.50 (0.14–1.73) 1.10 (0.41–2.94) 0.99 (0.96–1.04) 1.01 (0.99–1.03)
1.10 (0.76–1.60)
*Academic practice and private practice with academic affiliation merged as one category and compared with private practice only as the referent category.
and 4) revealed that only age had a significant inverse association with a providers’ ability to calculate non-HDL-C (odds ratio 0.45, 95% confidence interval 0.24–0.85). Type of provider (physician vs nonphysician), specialists versus nonspecialist provider, academic versus non-academic practice setting, years since completing training, percentage of patients with dyslipidemia in a provider’s panel, and provider’s use of specialized lipid testing were not associated with providers’ ability to calculate non-HDL-C levels or knowledge regarding non-HDL-C treatment goals. Conclusions: Major gaps remain in providers’ awareness regarding non-HDL-C treatment goals and their ability to calculate non-HDL-C levels. These gaps are systemic and not restricted to specialists or non-specialists. Therefore, there is a need to implement system level interventions across specialties to address these gaps.
125 Inappropriate Use of Fibrate Therapy in a UniversityBased Primary Care Clinic Setting*
and a 2007 National Lipid Association safety statement, fibrate therapy requires renal dosing adjustments. Purpose: To determine the appropriateness of fibrate prescribing within a university-based primary care population using the medication appropriateness index (MAI). The MAI is a validated instrument that assesses 10 aspects of medication use (indication, effectiveness, dosage, directions, practicality, interactions (drug and disease), duplication, duration, and cost). A secondary objective was to quantify changes in serum creatinine (SCr) and glomerular filtration rate (GFR) after initiation of fibrate therapy. Methods: The MAI was used retrospectively to determine appropriateness of fibrate prescribing from January 2003 through July 2009. Data collected were stratified by each of the 10 MAI criteria. Baseline and follow-up measures of kidney function were recorded for all included patients within 12 months of fibrate initiation. Changes in SCr and GFR were evaluated. Results: Electronic health records of 386 patients who were prescribed fibrate therapy were evaluated and 113 met study criteria. Overall, 64 percent of patients (72/113) had an MAI score $3, indicating inappropriate therapy. Thirty-five percent of patients (40/113) were prescribed therapy that was not indicated. Eleven percent of the entire study population warranted renal dose adjustment of their fibrate therapy and only 2/12 patients received appropriate dose reductions. Among all patients, 76% (87/113) had at least one of the 10 MAI criteria as inappropriate. Average changes in SCr and GFR from baseline were 0.08 mg/dL (P , .00001) and 5.6 mL/min/1.73m2 (P , .0001), respectively. Increases in SCr from baseline were greater with fenofibrate than gemfibrozil (0.14 and 0.04 mg/dL, respectively; P , .01). Conclusions: Prescribing of fibrates within this primary care population was inappropriate. The most common reasons for inappropriate use were lack of an indication for fibrate therapy and failure to renally adjust dosing. These data also demonstrated an increase in SCr with fibrate therapy, although changes were more pronounced with fenofibrate than with gemfibrozil.
126 Prevalence of LDL Dyslipidemia, Assessment of Goal Attainment and Variables Associated with Goal Attainment in HIV+ Patients in a Dedicated HIV Clinic
Jonathan R. White, PharmD, Joel Marrs, PharmD, Joseph Saseen, PharmD, (Portland, OR)
Merle Myerson, MD, Shuki Cohen, PhD, Joyce Park, Paul Galatowitsch, PhD, Antonio Urbina, MD, Victoria Sharp, MD, (Thornwood, NY)
Synopsis: Fibrates are used for treatment of hypertriglyceridemia and mixed dyslipidemia. However, their exact role in therapy is not well defined by the most recent Adult Treatment Panel III guidelines. For this reason, fibrates may not be prescribed appropriately, especially in primary care. According to Food and Drug Administration labeling
Synopsis: Patients with HIV infection are known to be at greater risk for cardiovascular disease (CVD); however, limited data exists on how effectively clinicians diagnose and treat dyslipidemia in these patients. Purpose: To evaluate the prevalence of low-density lipoprotein (LDL) dyslipidemia, the extent to which patients
213
Table 4 Independent predictors associated with providers’ knowledge of treatment goal for non-HDL-C Variable Male gender Age of the provider (per 10-year increase) Years since finishing residency or fellowship training (as a continuous variable) Physician provider (nonphysician providers as referent) Specialty provider (primary care providers as referent) Academic affiliation* Number of outpatients seen daily (as a continuous variable) Percent of patients in a provider’s panel with diagnosis of dyslipidemia (as a continuous variable) Use of specialized lipid testing (no use or rare use as referent)
Odds ratio (95% confidence interval) 0.43 (0.17–1.10) 0.64 (0.33–1.24) 1.05 (0.98–1.13)
0.95 (0.34–2.67) 0.50 (0.14–1.73) 1.10 (0.41–2.94) 0.99 (0.96–1.04) 1.01 (0.99–1.03)
1.10 (0.76–1.60)
*Academic practice and private practice with academic affiliation merged as one category and compared with private practice only as the referent category.
and 4) revealed that only age had a significant inverse association with a providers’ ability to calculate non-HDL-C (odds ratio 0.45, 95% confidence interval 0.24–0.85). Type of provider (physician vs nonphysician), specialists versus nonspecialist provider, academic versus non-academic practice setting, years since completing training, percentage of patients with dyslipidemia in a provider’s panel, and provider’s use of specialized lipid testing were not associated with providers’ ability to calculate non-HDL-C levels or knowledge regarding non-HDL-C treatment goals. Conclusions: Major gaps remain in providers’ awareness regarding non-HDL-C treatment goals and their ability to calculate non-HDL-C levels. These gaps are systemic and not restricted to specialists or non-specialists. Therefore, there is a need to implement system level interventions across specialties to address these gaps.
125 Inappropriate Use of Fibrate Therapy in a UniversityBased Primary Care Clinic Setting*
and a 2007 National Lipid Association safety statement, fibrate therapy requires renal dosing adjustments. Purpose: To determine the appropriateness of fibrate prescribing within a university-based primary care population using the medication appropriateness index (MAI). The MAI is a validated instrument that assesses 10 aspects of medication use (indication, effectiveness, dosage, directions, practicality, interactions (drug and disease), duplication, duration, and cost). A secondary objective was to quantify changes in serum creatinine (SCr) and glomerular filtration rate (GFR) after initiation of fibrate therapy. Methods: The MAI was used retrospectively to determine appropriateness of fibrate prescribing from January 2003 through July 2009. Data collected were stratified by each of the 10 MAI criteria. Baseline and follow-up measures of kidney function were recorded for all included patients within 12 months of fibrate initiation. Changes in SCr and GFR were evaluated. Results: Electronic health records of 386 patients who were prescribed fibrate therapy were evaluated and 113 met study criteria. Overall, 64 percent of patients (72/113) had an MAI score $3, indicating inappropriate therapy. Thirty-five percent of patients (40/113) were prescribed therapy that was not indicated. Eleven percent of the entire study population warranted renal dose adjustment of their fibrate therapy and only 2/12 patients received appropriate dose reductions. Among all patients, 76% (87/113) had at least one of the 10 MAI criteria as inappropriate. Average changes in SCr and GFR from baseline were 0.08 mg/dL (P , .00001) and 5.6 mL/min/1.73m2 (P , .0001), respectively. Increases in SCr from baseline were greater with fenofibrate than gemfibrozil (0.14 and 0.04 mg/dL, respectively; P , .01). Conclusions: Prescribing of fibrates within this primary care population was inappropriate. The most common reasons for inappropriate use were lack of an indication for fibrate therapy and failure to renally adjust dosing. These data also demonstrated an increase in SCr with fibrate therapy, although changes were more pronounced with fenofibrate than with gemfibrozil.
126 Prevalence of LDL Dyslipidemia, Assessment of Goal Attainment and Variables Associated with Goal Attainment in HIV+ Patients in a Dedicated HIV Clinic
Jonathan R. White, PharmD, Joel Marrs, PharmD, Joseph Saseen, PharmD, (Portland, OR)
Merle Myerson, MD, Shuki Cohen, PhD, Joyce Park, Paul Galatowitsch, PhD, Antonio Urbina, MD, Victoria Sharp, MD, (Thornwood, NY)
Synopsis: Fibrates are used for treatment of hypertriglyceridemia and mixed dyslipidemia. However, their exact role in therapy is not well defined by the most recent Adult Treatment Panel III guidelines. For this reason, fibrates may not be prescribed appropriately, especially in primary care. According to Food and Drug Administration labeling
Synopsis: Patients with HIV infection are known to be at greater risk for cardiovascular disease (CVD); however, limited data exists on how effectively clinicians diagnose and treat dyslipidemia in these patients. Purpose: To evaluate the prevalence of low-density lipoprotein (LDL) dyslipidemia, the extent to which patients