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Fewer e-prescribing alerts could save lives

BY Alaric DeArment

NEW YORK —More than a million Americans become sick, injured or die every year because of medication errors, many of which result from physicians’ stereotypically illegible handwriting on prescription pads.

Electronic prescribing has long been touted as a solution to the problem, especially e-prescribing systems that automatically alert prescribers to potential interactions between drugs. According to a study published last month in the Archives of Internal Medicine, however, doctors override more than 90% of drug interaction alerts. Nevertheless, the systems still prevent a significant number of harmful drug interactions, and they could go further if needless alerts were eliminated.

“Electronic prescribing alerts in ambulatory care may prevent a substantial number of injuries and reduce healthcare costs in Massachusetts,” the researchers wrote in their conclusion. “Because a few alerts account for most of the benefit, e-prescribing systems should suppress low-value alerts.”

Harvard Medical School associate professor and Dana-Farber Cancer Institute researcher Saul Weingart and colleagues used data from 279,476 alerted prescriptions written by 2,321 ambulatory care clinicians in Massachusetts who used ZixCorp’s PocketScript e-prescribing application between Jan. 1 and June 30, 2006. PocketScript allows physicians to submit prescriptions to pharmacies by computer, creating a patient medication profile based on previous prescriptions, checking newly prescribed medications against a database and alerting physicians to potential low-, medium- or high-severity interactions.

An expert panel of four physicians and three pharmacists estimated the likelihood and severity of potential drug interactions that might occur with each alert, along with likely harm to the patient and healthcare utilization needed to address them, using a sample of 100 common drug interaction alerts. The researchers then created cost estimates using published sources and payer data, such as the average cost of a medical hospitalization or doctor visit due to an adverse drug event.

Based on the estimates, the researchers found that, even though physicians overrode 91% of drug interaction alerts, the alerts they accepted likely prevented 402 adverse drug events. These included three potential deaths, 14 cases of permanent disability and 31 cases of temporary disability. The alerts also resulted in 34 fewer emergency room visits, 39 fewer hospitalizations and 267 fewer doctor office visits, producing a cost savings of $402,619. In all, the researchers estimated, it took 331 alerts to prevent one adverse drug event, and 10% of alerts may have accounted for 78% of cost savings.

One problem, however, was “alert fatigue,” and the researchers wrote that eliminating unneeded alerts would help prevent it. “[We] believe that the technology’s ability to prevent [adverse drug events] makes it worthwhile, and our findings suggest that significant efficiencies could be gained by reducing overalerting,” the researchers wrote. “Doing so would mitigate alert fatigue, thereby increasing the percentage of clinically significant alerts accepted and the number of [adverse drug events] averted.”

The researchers also acknowledged several limitations in the study, such as the exclusion of redundant alerts and formulary adherence and allergy alerts, as well as not taking into consideration cost savings resulting from formulary adherence, prevention of allergic reactions, use of generic drugs and legible prescriptions.

Nevertheless, streamlining the alert system would produce potential benefits, they found. “Our study suggests that drug alerts have the potential to prevent harm and reduce healthcare costs,” the researchers wrote. “To do so, however, clinicians need relief from alerts with little clinical value.”

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Hy-Vee celebrates the other white meat

BY Alaric DeArment

WEST DES MOINES, Iowa A lot of people complain about pork barrel spending, but not Midwest supermarket chain Hy-Vee.

October is National Pork Month, and the West Des Moines, Iowa-based Hy-Vee announced Friday that sales of the meat have increased more than 25% over October 2008. The chain said it was on track to increase pork tonnage by more than 30%.

 

“With pork prices the lowest they’ve been in more than a decade, we’ve focused our marketing efforts on promoting pork as a great value for consumers,” Hy-Vee assistant VP meat operations Kenan Judge said in a statement. “Today’s shopper is looking for nutritious, economical meal ideas, and pork perfectly fits the bill.”

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Patients prefer new diabetes drug Victoza over its competitor, survey finds

BY Alaric DeArment

MONTREAL A new diabetes drug satisfied patients more than its competitor, according to a study funded by the drug’s manufacturer.

According to data on 379 patients who took the Diabetes Treatment Satisfaction Questionnaires, presented Thursday at the 20th World Diabetes Congress and published in medical journal The Lancet, patients taking Novo Nordisk’s drug Victoza (liraglutide) perceived less abnormally low or high blood sugar levels — known respectively as hypoglycemia and hyperglycemia — than those taking Byetta (exenatide), made by Eli Lilly & Co., Amylin Corp. and Alkermes.

Victoza is approved in Europe, but Novo Nordisk is still waiting for approval from the Food and Drug Administration in the United States.

“Liraglutide has shown here in a convincing study that it is associated with less nausea, less perceived hypoglycemia and definitely higher patient satisfaction compared to exenatide,” principal investigator Wolfgang Schmidt said in a statement. “Patient-reported outcomes data is an important extension of the efficacy data. If a patient is satisfied with his or her treatment, then they are much more likely to really stick to the treatment over the long term, which is necessary in Type 2 diabetes.”

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