A retrospective evaluation of vitamin K1 therapy to reverse the anticoagulant effect of warfarin.

STUDY OBJECTIVE: To assess compliance with the 2001 consensus guidelines of the American College of Chest Physicians (ACCP) regarding administration of vitamin K1 to reverse the anticoagulant effect of warfarin. DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: Fifty-five adult inpatients who received both warfarin and vitamin K1 between September 2001 and January 2002. MEASUREMENTS AND MAIN RESULTS: The patients' medical records were evaluated; data were collected on patient demographics and on vitamin K1 dosage and route of administration, warfarin dosage, and international normalized ratio (INR) before and after vitamin K1 administration. Administration routes and 87 doses of vitamin K1 prescribed for the 55 patients were assessed for compliance with the ACCP guidelines. Administration routes were subcutaneous (40.2% of doses), intravenous (35.6%), oral (13.8%), and intramuscular (10.3%). The most frequently prescribed dose of vitamin K1 was 10 mg (32.2%), followed by 2 mg (21.8%) and 5 mg (18.4%). Rates of compliance with the ACCP guidelines categorized by INR value were as follows: INR below 5, 12.2%; INR 5-9, 27.8%; INR between 9 and 20, 26.7%; and INR above 20, 0%. Four patients had documented episodes of bleeding and received seven doses of vitamin K1. Twenty-six patients received fresh frozen plasma with vitamin K1. Overall compliance with ACCP-recommended doses and routes of vitamin K1 was only 17.2%. CONCLUSION: The most frequently prescribed administration routes for vitamin K1 were subcutaneous and intravenous, indicating that the oral route is often not used as recommended. The vitamin K1 doses prescribed for reversal of warfarin anticoagulation were highly variable, and for most (83%) patients, the recommended guidelines were not followed. The clinical significance of noncompliance with the ACCP guidelines for vitamin K1 administration warrants further study.

Clinical inertia in type 2 diabetes: A retrospective analysis of pharmacist-managed diabetes care vs. usual medical care.

BACKGROUND: Evidence suggests that patients with type 2 diabetes (T2DM) suffer from a high rate of "clinical inertia" or "recognition of the problem but failure to act." OBJECTIVE: THE AIM OF THIS STUDY IS TO QUANTIFY THE RATE OF CLINICAL INERTIA BETWEEN TWO MODELS OF CARE: Pharmacist-Managed Diabetes Clinic (PMDC) vs. Usual Medical Care (UMC). METHODS: Patients in a university based medical clinic with type 2 diabetes (T2DM) were analyzed in this retrospective cohort study. Patients were exposed to either PMDC or UMC. The difference in days to intervention in response to suboptimal laboratory values and time to achieve goal hemoglobin A1c (A1c), systolic blood pressure (SBP) and low-density lipoprotein (LDL) was compared in the two models of care. RESULTS: A total of 113 patients were included in the analysis of this study, 54 patients were in the PMDC and 59 patients were in the UMC group. Median time (days) to intervention for A1c values >7% was 8 days and 9 days in the PMDC and UMC groups, respectively (p>0.05). In patients with baseline A1c values >8%, median time to achieving A1c<7% was 259 days vs. 403 days in the PMDC and UMC groups, respectively (p<0.05). Median time to goal SBP was 124 days in the PMDC group and 532 days in the UMC group (p<0.05). Median time to goal LDL was 412 days in the PMDC group vs. 506 days in the UMC group (p<0.05). CONCLUSIONS: Rates of clinical inertia, defined as time to intervention of suboptimal clinical values, did not differ significantly between patients enrolled in a PMDC compared to patients with UMC with respect to A1c, SBP and LDL. Participation in PMDC, however, was associated with achieving goal A1c, SBP, and LDL levels sooner compared to UMC.

Clinical inertia in type 2 diabetes: a retrospective analysis of pharmacist-managed diabetes care vs. usual medical care / Inercia clínica en diabetes tipo 2: análisis retrospectivo de cuidados diabéticos por farmacéuticos contra cuidados médicos habituales

BACKGROUND: Evidence suggests that patients with type 2 diabetes (T2DM) suffer from a high rate of "clinical inertia" or "recognition of the problem but failure to act." OBJECTIVE: The aim of this study is to quantify therate of clinical inertia between two models of care: Pharmacist-Managed Diabetes Clinic (PMDC) vs. Usual Medical Care (UMC). METHODS: Patients in a university based medical clinic with type 2 diabetes (T2DM) were analyzed in this retrospective cohort study. Patients were exposed to either PMDC or UMC. The difference in days to intervention in response to suboptimal laboratory values and time to achieve goal hemoglobin A1c (A1c), systolic blood pressure (SBP) and low-density lipoprotein (LDL) was compared in the two models of care. RESULTS: A total of 113 patients were included in the analysis of this study, 54 patients were in the PMDC and 59 patients were in the UMC group. Median time (days) to intervention for A1c values >7% was 8 days and 9 days in the PMDC and UMC groups, respectively (p > 0.05). In patients with baseline A1c values >8%, median time to achieving A1c<7% was 259 days vs. 403 days in the PMDC and UMC groups, respectively (p < 0.05). Median time to goal SBP was 124 days in the PMDC group and 532 days in the UMC group (p < 0.05). Median time to goal LDL was 412 days in the PMDC group vs. 506 days in the UMC group (p < 0.05). CONCLUSIONS: Rates of clinical inertia, defined as time to intervention of suboptimal clinical values, did not differ significantly between patients enrolled in a PMDC compared to patients with UMC with respectto A1c, SBP and LDL. Participation in PMDC, however, was associated with achieving goal A1c, SBP, and LDL levels sooner compared to UMC (AU)

ANTECEDENTES: La evidencia sugiere que los pacientes con diabetes tipo 2 (T2DM) padecen elevada "inercia clínica" o "reconocimiento del problema pero fracaso en la actuación". OBJETIVO: El objetivo de este estudio es cuantificar la tasa de inercia clínica entre dos modelos de cuidados: consulta de diabetes gestionada por farmacéutico (PMDC) vs. cuidados médicos habituales (UMC). MÉTODOS: Se analizó en este estudio de cohorte retrospectiva a los pacientes con diabetes tipo 2 de una clínica médica universitaria. Los pacientes estuvieron expuestos a PMDC o a UMC. Se comparó la diferencia entro los dos modelos de cuidados en días desde la intervención en la respuesta a los valores sub-óptimos de laboratorio y el tiempo en alcanzar los objetivos de hemoglobina A1c (A1c) presión arterial sistólica (SBP) y lipoproteínas de baja densidad (LDL). RESULTADOS: Se incluyó en el análisis de este estudio a un total de 113 pacientes, 54 en el grupo PMDC y 59 en el UMC. La mediana de tiempo (días) desde la intervención para valores de A1c >7% fue de 8 y 9 días en los grupos PMDC y UMC, respectivamente (p > 0,05). En los pacientes con A1c basal>8%, la mediana de tiempo para alcanzar una A1c<7% fue de 259 días vs. 403 días en los grupos PMDC y UMC, respectivamente (p < 0,05). El tiempo medio hasta el objetivo de SBP fue de 124 días en el grupo PMDC y 532 en el UMC (p < 0,05). La mediana de tiempo para el objetivo de LDL fue de 412 días en el grupo PMDC vs. 506 días en el UMC (p < 0,05). CONCLUSIONES: Las tasas de inercia clínica, definidos como el tiempo desde la intervención de valores clínicos sub-óptimos, no difirieron significativamente entre los pacientes incluidos en un PMDC comparados con pacientes en UMC en relación a A1c, SBP y LDL. Sin embargo, la participación en un PMDC estuvo asociado con alcanzar el objetivo de niveles de A1c, SBP y LDL más rápido, comparado con el UMC (AU)