Clinical Pharmacist–Led Impact on Inappropriate Albumin Utilization and Associated Costs in General Ward Patients

Abstract

Background: Inappropriate albumin use in clinical practice remains problematic. Health-systems face continued challenges in promoting cost-appropriate use. Objective: To evaluate the clinical and economic impact of a clinical pharmacist–led intervention strategy targeting inappropriate albumin use in general ward patients. Methods: A retrospective cohort study evaluated all adult (≥18 years) general ward patients administered ≥1 dose of albumin at a university medical center over a 2-year period. The intervention consisted of a clinical pharmacist–led strategy intervening on all albumin orders not in accordance with institutional guidelines. The primary end point was to compare inappropriate albumin utilization before and after implementation. Secondary end points compared the rates of inappropriate albumin use adjusted for hospital admission and patient-days as well as associated costs by appropriateness between study periods. Results: A total of 4420 patients were screened, with 1971 (44.6%) patients meeting inclusion criteria. The clinical pharmacist strategy significantly reduced inappropriate albumin (grams) utilization by 86.0% ( P < 0.001). A 7-fold reduction of inappropriate albumin administered adjusted for the number of patient admissions was found from the preimplementation period following clinical pharmacist intervention strategy implementation (415.3 ± 83.2 vs 57.5 ± 34.2 g per 100 general ward hospital admissions, respectively; P < 0.001). Also, the adjusted inappropriate albumin rate was reduced from 62.2 ± 12.3 to 8.6 ± 5.2 g per 100 patient-days in the preimplementation and postimplementation periods, respectively ( P < 0.001). Annual cost savings were $421 455 overall, with $341 930 resulting from mitigation of inappropriate use. Conclusion and Relevance: Clinical pharmacist–led interventions significantly reduced inappropriate albumin use and costs in hospitalized patients.

Strategies for de-implementation of low-value care—a scoping review

“…Accountability tools included various tools that provided a gatekeeping function through which the clinicians were held accountable for their decision to use a low-value practice. They were requested to provide an argument as to why they were planning to use a low-value practice either by means of a written answer in the electronic health record or a verbal response to a colleague, specialist, or pharmacist (e.g., [95,96]). Black box warnings were warning text on drug packages about the risk of the LVC drug so as to make both the clinician and patient aware of its risks (e.g., [97]).…”

Prescribers’ Compliance to Human Serum Albumin Usage Criteria and Its Implication on Cost Saving

“…Due to a lack of definite criteria for use, HSA can potentially be used in several off-label conditions (Caraceni, Domenicali et al, 2013; Caraceni, Tufoni et al, 2013). From a healthcare provider’s perspectives, HSA is a well-known expensive medication requiring a strategy to ensure appropriate usage to avoid unnecessary loss of healthcare resources (Buckley et al, 2021). As a result, the study evaluating the appropriateness of use through the DUE programme may help shed some light on the current situation of HSA use along with providing important information that can be used to design appropriate interventions to improve HSA use in a healthcare institution.…”

“…This may partly be a result of differences in usage criteria from our study that differed from criteria of other studies. Criteria used in other studies were derived from clinical practice guideline (Dastan et al, 2018; Foroughinia & Mazraie, 2017; Farsad et al, 2016; Farasatinasab et al, 2018; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Shafiee et al, 2016; Torbic et al, 2020), primary literature (Dastan et al, 2018; Jahangard-Rafsanjani et al, 2011; Nejad et al, 2010; Torbic et al, 2020), AHFS drug information (Aramwit & Kasettratat, 2004; Talasaz et al, 2012) or institutional guideline (Buckley et al, 2021; Tanzi et al, 2003) at the time when those studies were conducted. For our study, due to the limited resources, we placed emphasis on indications where HSA’s roles were well substantiated with clinical evidence and where justification of use can objectively and easily be measured.…”

Reducing Human Album Solution Use in the Pediatric Intensive Care Unit

“…However, in a recent study, a clinical pharmacist-led strategy intervening on all albumin orders noncompliant with institutional guidelines significantly reduced inappropriate albumin use and costs in hospitalized patients. 18 Creating guidelines and evaluating albumin use appropriateness would be our next goal since our institution lacks institutional guidelines on albumin use and albumin stewardship.…”