Budget Impact Analysis of a Renal Point-of-Care Test in Dutch Community Pharmacies to Prevent Antibiotic-Related Hospitalizations

Gout-Zwart, Judith J; Hengel, Erien H. J. Olde; Hoogland, Petra; Postma, Maarten J.

doi:10.1007/s40258-018-0426-2

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…Of these 635 medications, 50 (7.9%) were affected by kidney function. Dose adjustment was recommended in 31 and discontinuation in 19. The primary care doctor accepted the recommendations for 14…”

Section: Resultsmentioning

confidence: 99%

“…Among them are services related to CKD, including screening and detection of asymptomatic patients [ 16 ], advice and reconciliation of medication in patients at hospital discharge [ 17 ], subsequent follow-up to detect medication related complications, including non-compliance [ 18 ]. In addition, a 2019 study used POCT measurement of kidney function (GFR) in community pharmacies in the Netherlands to prevent hospitalizations related to antibiotic adverse events [ 19 ]. In this study, the authors showed an annual saving of €86 per patient thanks to the possibility of measuring kidney function in Dutch community pharmacies.…”

Section: Introductionmentioning

confidence: 99%

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Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study

Escribá-Martí¹,

Cámara-Ramos

Climent-Catalá³

et al. 2022

PLoS ONE

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Introduction Chronic kidney disease (CKD) is a major health problem. Early detection is the key to reducing morbidity and mortality, but it is difficult because it occurs without symptoms. Diagnosis of CKD is also important to avoid nephrotoxic drugs and to adjust the doses of other medications that may be affected. Pharmacies, due to their proximity to the population, frequency of patient visits, and knowledge of medication use are an ideal location for point-of-care diagnosis or CKD. Objective To detect and refer to the primary care physician patients with low estimated glomerular filtration rate (eGFR) who use nephrotoxic drugs or who may require a dose adjustment. Methodology Pharmacy users over 60 years of age who agreed to participate were given a creatinine/eGFR test with a point-of-care meter. The eGFR was calculated and if it was less than 60 ml/min/1.73 m2, their medications were evaluated to identify nephrotoxic drugs or drugs that potentially required adjustment. If either were found, they were referred to their doctor for further management. Results 198 patients were recruited in 4 pharmacies, of which 87 (43.9%) had an eGFR less than 60 ml/min/1.73 m2. They were taking a total of 635 medications. Of these 635 medications, 50 (7.9%) were affected by kidney function. Dose adjustment was recommended in 31 and discontinuation in 19. The primary care doctor accepted the recommendations for 14 medications: dose adjustment for 6 and withdrawal in 8. This represents 2.3% of medications taken by patients with an eGFR less than 60 ml/min/1.73 m2. The 50 medications identified were taken by 29 patients (33.3% of the 87 with a low eGFR) and a change in treatment was generated in 9 patients, representing 4.6% of the total number of patients in the sample, and 10% of the patients with a low eGFR. Conclusion Point-of-care testing for kidney function in a pharmacy setting is feasible and identifies a significant number of patients with eGFR under 60 ml/min/1.73 m2. It also allows for appropriate medication management recommendations in this patient group.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study

Escribá-Martí¹,

Cámara-Ramos

Climent-Catalá³

et al. 2022

PLoS ONE

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“…LAB and POCT populations had a homogeneous distribution regarding age, creatinine, and glomerular filtration, essential data for establishing basal renal function. 10,13,17 Taking this into account, we considered that differences found during the study were not due to basal variation among LAB and POCT patients. There was only heterogeneity in sex distribution, which might affect some of the differences obtained.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4]7,8,11,12 Publications available about POCT methods aimed at nephrologic patients are mostly for diagnosis and do not include BGA. [13][14][15][16] To the best of our knowledge, the present study assesses clinical, operative, and economic outcomes of POCT BGA in a nephrology department for the first time.…”

mentioning

confidence: 99%

Clinical, Operative, and Economic Outcomes of the Point-of-Care Blood Gases in the Nephrology Department of a Third-Level Hospital

Moreno

Sáez

Calle

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Point-of-care testing allows rapid analysis and short turnaround times. To the best of our knowledge, the present study assesses, for the first time, clinical, operative, and economic outcomes of point-of-care blood gas analysis in a nephrology department. Objective.— To evaluate the impact after implementing blood gas analysis in the nephrology department, considering clinical (differences in blood gas analysis results, critical results), operative (turnaround time, elapsed time between consecutive blood gas analysis, preanalytical errors), and economic (total cost per process) outcomes. Design.— A total amount of 3195 venous blood gas analyses from 688 patients of the nephrology department before and after point-of-care blood gas analyzer installation were included. Blood gas analysis results obtained by ABL90 FLEX PLUS were acquired from the laboratory information system. Statistical analyses were performed using SAS 9.3 software. Results.— During the point-of-care testing period, there was an increase in blood glucose levels and a decrease in pCO2, lactate, and sodium as well as fewer critical values (especially glucose and lactate). The turnaround time and the mean elapsed time were shorter. By the beginning of this period, the number of preanalytical errors increased; however, no statistically significant differences were found during year-long monitoring. Although there was an increase in the total number of blood gas analysis requests, the total cost per process decreased. Conclusions.— The implementation of a point-of-care blood gas analysis in a nephrology department have a positive impact on clinical, operative, and economic terms of patient care.

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“…This includes a role for simple-to-use, point-of-care (POC) creatinine methods, which potentially can be used for creatinine self-monitoring similar to self-monitoring blood glucose or blood ketone devices. The use of a POC whole blood creatinine monitoring system (BCMS) has been shown to be feasible and cost-effective in primary care settings and pharmacies, providing improvements to clinical services and cost savings in patient care [ 15 , 16 , 17 ]. However, a crucial issue in both evaluating and using a BCMS in CKD prevalence studies is the level of standardization of the test and reference methodology.…”

Section: Introductionmentioning

confidence: 99%

Creatinine standardization: a key consideration in evaluating whole blood creatinine monitoring systems for CKD screening

et al. 2022

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Early detection of CKD using point of care creatinine and eGFR testing improves patient management outcomes. We undertook a field study to evaluate the use of a whole blood creatinine/eGFR device to screen a rural Nicaraguan population to determine the variability between creatinine methods and specimen types. All specimens including capillary and venous dried blood spots (DBS) were tested with an isotope dilution liquid chromatography mass spectrometry (ID-LCMS) gold standard method. This is to our knowledge the first time a capillary whole blood (POC) method has been directly compared to the gold standard IDMS method, through the novel approach of using dried blood spots. Capillary and venous whole blood specimens were obtained and tested directly with the BCMS method, and then, DBS samples were prepared. Venous plasma specimens were tested using three laboratory analyzer creatinine methods. DBS were sent to the site performing ID-LCMS. Control samples were also prepared to assess the stability of shipment and storage of DBS. The ID-LCMS method was aligned using primary and secondary standards. Sixty-six (66) patients participated in the study, and the CKD prevalence rate was 7.8%. While all creatinine methods showed a good correlation to ID-LCMS, there was a positive bias (mean absolute bias range: 0.21–0.63 mg/dL). All methods used were 100% sensitive, but specificity varied from 62.7 to 94.9% with PPV ranging from 25 to 62.5%. A correction factor was used to align the values from each method to ID-LCMS which improved the specificity of each method. This study used a unique DBS approach to align capillary whole blood creatinine to ID-LCMS. To ensure reliability of BCMS for identifying screened patients with CKD, it is important to establish IDMS traceability and alignment prior to undertaking CKD studies.

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Budget Impact Analysis of a Renal Point-of-Care Test in Dutch Community Pharmacies to Prevent Antibiotic-Related Hospitalizations

Abstract: Obtaining and evaluating renal function in community pharmacies by point of care tests is expected to be cost-saving in the Netherlands.

Cited by 8 publications

References 13 publications

Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study

Pharmaceutical care program for patients with chronic kidney disease in the community pharmacy: Detection of nephrotoxic drugs and dose adjustment. Viability study

Clinical, Operative, and Economic Outcomes of the Point-of-Care Blood Gases in the Nephrology Department of a Third-Level Hospital

Creatinine standardization: a key consideration in evaluating whole blood creatinine monitoring systems for CKD screening

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