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Antimicrobial Stewardship Yields Dramatic Cost Savings

A program designed to monitor the use of antimicrobial drugs at the University of Maryland Medical Center yielded dramatic cost savings without sacrificing quality of care, according to results of a study published in the April 2012 issue of Infection Control and Hospital Epidemiology. The program, which was in place from 2001 to 2008, involved a clinical pharmacist and a part- time physician, both specially trained in infectious diseases, who monitored antimicrobial orders in real time and performed active intervention and education when necessary.

The researchers found that antimicrobial costs decreased 45.8% during the 7 years the program was in effect, from $44,181 to $23,933 per 1000 patient-days. Much of the decrease in costs was due to reduction in use of antifungal agents in cancer treatment. (In the program’s first 3 years, during which the hospital reduced annual antimicrobial costs by almost $3 million, the cost of antifungals was reduced by 60.7% and the cost of antibiotics was reduced by 14.6%.)

The program was discontinued to pay for more infectious diseases physicians, who were expected to provide the necessary antimicrobial stewardship, rendering the monitoring program superfluous. In the first 2 years after the program was ended, however, antimicrobial costs shot up 32.3% to $31,653 per 1000 patient-days, with most of the increase in the antibiotic category. The researchers note that there were no significant changes in patient length of stay, readmission rate, or mortality before, during, or after the period when the program was in effect.

 

Women Prescribed More Drugs, but Have Poorer Adherence

Women are prescribed more medications than men, but are less likely to be prescribed medications based on clinical guide- lines and less likely to adhere to medications once prescribed, according to the results of a new study by Medco Health Solutions and the Society for Women’s Health Research. The study, which looked at insurance records for 30 million Americans during 2010, excluded prescription contraceptives from its data.

The researchers found that women were prescribed an average of 5 drugs compared with 3.7 for men and that 68% of women were prescribed medi- cation for acute or chronic illnesses compared with 59% of men. However, they found that women were worse at monitoring their diseases and managing 2 specific chronic conditions: diabetes and cardiovascular disease. For the latter, women performed more poorly in 11 out of 11 metrics of disease management. For example, 59% of women with cardiovascular disease took medication to lower their cholesterol compared with 71.5% of men.

The researchers suggest that physiologic differences may account for women’s decision to discontinue their medication, pointing out that men are over-represented in early stage drug trials, which may prevent researchers from taking into account how drugs affect women.

Pharmacists should be aware that women may be more likely than men to stop using medications if they experience negative side effects or do not see the kind of results they expect. It is important to discuss medication profiles with female patients before they decide to stop taking prescribed drugs.