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Purpose: On January 3, 2012, Mercy Hospital St. Louis changed its formulary erythropoiesis-stimulating agent (ESA) from epoetin alfa to darbepoetin alfa and concurrently instituted a new pharmacy-driven ESA utilization program. The objective of this study was to determine the impact of a pharmacy-driven ESA utilization program on appropriate use of ESAs.
Methods: Prior to the formulary change and the initiation of the pharmacy-driven ESA utilization program, pharmacists received training on the expected monitoring and documentation process for appropriate utilization of ESAs as approved by the hospital’s pharmacy and therapeutics committee. Adult patients with an indication for an ESA of anemia of chronic kidney disease with or without hemodialysis or chemotherapy induced anemia treated with epoetin alfa from January 15 through February 15, 2011 (pre-implementation) or darbepoetin alfa from January 15 through February 15, 2012 (post-implementation) were included. Data including ESA indication, dose, frequency, last dose administered, patient weight, hemoglobin, ferritin, and transferrin saturation was collected. The primary outcome was the difference in the proportion of patients appropriately administered an ESA before and after implementing a pharmacy-driven ESA utilization program.
Results: Fifty patients were included in the pre-implementation group and 58 patients in the post-implementation group. There was no significant difference in baseline demographics between groups. Twenty-six percent of patients in the pre-implementation group were appropriately administered an ESA compared to 43% in the post-implementation group (p=0.0721). Sub-analysis of the primary outcome showed that appropriate dose was received by 44% compared to 57% of patients (p=0.2468), and appropriate laboratory monitoring occurred for 62% compared to 69% of patients (p=0.5427) in the pre- and post-implementation groups, respectively.
Conclusion: Implementation of a pharmacy-driven ESA utilization program did not significantly improve appropriate utilization of ESAs at Mercy Hospital St. Louis. An approach which includes significant educational strategies regarding standards associated with ESAs is necessary to optimize patient care.