NEW ORLEANS—Implementation of an explicit order form for darbepoetin alfa significantly improved compliance with current guidelines and led to large cost savings, California pharmacists report.
In July 2007, the Centers for Medicare & Medicaid Services (CMS) implemented stricter guidelines for treating chemotherapy-induced anemia with erythropoiesis-stimulating agents. “This changed the prescribing requirements and created some confusion,” said Siu-Fun Wong, PharmD, of the Hematology-Oncology Medical Group of Orange County, Orange, California, who presented the study at the meeting.
The lead author was her student, Stacy L. Yang, a PharmD candidate at Western University of Health Sciences College of Pharmacy in Pomona, California.
“We wanted to detect prescribing errors in the daily encounters with patients,” Wong said. To this end, the investigators retrospectively reviewed cases in which patients received darbepoetin alfa between May 2008 and February 2009. They discovered that in 50% of cases, the drugs were not given in accordance with the updated CMS guidelines.
“There was a fairly high noncompliance rate, and this also was associated with loss of revenue,” Wong said. In an effort to correct the high noncompliance event rate, they developed a Darbepoetin alfa (Aranesp) Administration Order Form (AAOF), then assessed compliance once it was instituted. The form is quite explicit, although it is designed to be self-directed. Staff attended in-service training on its use.
The study evaluated guideline compliance before use of the AAOF, involving 38 patients receiving 231 interventions. After implementation, 53 patients received 143 interventions.
Implementation of the AAOF significantly reduced noncompliance events pertaining to initial dosing and maintenance dose frequency, the review found.
Prior to the AAOF, 27 (71.1%) of 38 patients received an inappropriate initial weight-based dose but this practice occurred only in two (3.8%) of 53 patients when the form was used (P <.001). Inappropriate dose frequency occurred at baseline in 41 (17.7%) of 231 interventions, but with the AAOF, no cases occurred at all (P <.0001). There were no significant changes in inappropriate dosing, dose reduction, or dose escalation.
In total, there were 19 inappropriate documentations after the intervention, and in eight (15.1%) of 53 patients providers did not use the AAOF. Failure to document doses given or laboratory values occurred in <5% of interventions, she added.
“Most important, better compliance impacted reimbursement,” Wong said.
The projected cost-avoidance analysis showed that $72,611 per year was captured by implementation of the form.
The projected number of noncompliance events per year was 132 before AAOF and just 18 after AAOF, representing projected reimbursement losses of $84,076 versus $11,465.
“Even with the declining use of darbepoetin alfa, we saved the practice over $70,000,” she noted.