Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy

A cross-sectional study

Numan Alabdan, Yazed AlRuthia, Mary E.D. Yates, Ibrahim Sales, Christopher K. Finch, Joanna Laizure

Research output: Contribution to journalArticle

Abstract

Background: Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. Objective: The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. Methods: This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. Results: A total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03–1.65) and ferritin (OR = 3.91; 95% CI: 1.23–12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05–1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (β = 0.02349; P = 0.895). Conclusions: Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.

Original languageEnglish (US)
Article numbere0188390
JournalPloS one
Volume12
Issue number11
DOIs
StatePublished - Nov 1 2017

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Hematinics
erythropoiesis
cross-sectional studies
Inpatients
Cross-Sectional Studies
hemoglobin
Hemoglobins
kidney diseases
Length of Stay
Costs and Cost Analysis
therapeutics
ferritin
Tertiary Healthcare
Ferritins
Chronic Renal Insufficiency
Linear regression
Tertiary Care Centers
anemia
Chronic Kidney Failure
Logistics

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy : A cross-sectional study. / Alabdan, Numan; AlRuthia, Yazed; Yates, Mary E.D.; Sales, Ibrahim; Finch, Christopher K.; Laizure, Joanna.

In: PloS one, Vol. 12, No. 11, e0188390, 01.11.2017.

Research output: Contribution to journalArticle

Alabdan, Numan ; AlRuthia, Yazed ; Yates, Mary E.D. ; Sales, Ibrahim ; Finch, Christopher K. ; Laizure, Joanna. / Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy : A cross-sectional study. In: PloS one. 2017 ; Vol. 12, No. 11.
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abstract = "Background: Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. Objective: The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. Methods: This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. Results: A total of 242 patients were included. The majority of the prescribers (77{\%}) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95{\%} CI: 1.03–1.65) and ferritin (OR = 3.91; 95{\%} CI: 1.23–12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95{\%} CI:1.05–1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (β = 0.02349; P = 0.895). Conclusions: Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.",
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AB - Background: Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. Objective: The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. Methods: This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. Results: A total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03–1.65) and ferritin (OR = 3.91; 95% CI: 1.23–12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05–1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (β = 0.02349; P = 0.895). Conclusions: Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.

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