Albumin Utilization in a Teaching Hospital in Tehran: Time to Revise the Prescribing Strategies
Background: Since albumin imposes a relatively high cost to a healthcare system, drug use evaluation for this drug is much more important. This study wants to evaluate pattern of albumin use in a large university affiliated hospital in Tehran, Iran.
Methods: A concurrent, cross-sectional study was performed in “Shaheed Rajaei” Cardiovascular, Medical and Research Center. All inpatient adults that were prescribed albumin during the study period were evaluated to register the indications for albumin usage according to the evidence-based guidelines.
Results: Only for five patients (4%) the albumin prescriptions were justifiable. Of these cases, intractable edema was the leading cause of albumin misuse (73 patients; 60.8%). The total 1468 vials of Albumin were prescribed for 120 patients during the study period. The most common reasons to prescribe albumin were acute normovolemic (34%), cardiac failure (0.83%), resistance edema with Albumin>2g/dL (61%), nephrotic syndrome (0.83%), plasmapheresis (1.67%), ascetic (1.67%).
Conclusion: These data, together with previous national studies highly suggest a mandatory need for educational measures for practicing physicians along with strict regulations for prescription strategies regarding expensive drugs such as albumin.
Bowman I. Drug Use Evaluation is DUE: healthcare utilization evaluation is over-DUE. Hosp Pharm 1996; 3:5-8.
Sacristan J, Soto J. Drug utilization studies as tools in health economics. Pharmacoeconomics 1994; 5(4):299-312.
Missan G, Alderman C, Brown E, et al. SHPA Standards of practice for drug usage evaluation in Australian hospitals. AJHP 1996; 26:240-7.
ASHP. ASHP guidelines on medication-use evaluation. Am J Health-Syst Pharm 1996; 53:1953-5.
Gales BJ. Adverse reactions to human serum albumin. Ann Pharmacother 1993; 27: 87–94
Apelgren KM, Romheau JL, Twomey PL, et al. Comparison of nutritional indices and outcome in critically ill patients. Crit Care Med 1982; 10: 305– 307
Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G.Italian. Recommendations for the use of albumin and immunoglobulins. Blood Transfus 2009; 7(3):216-34.
Somers A, Bauters T, Robays H, Bogaert M, Colardyn F. Evaluation of human albumin use in a university hospital in Belgium. Pharm World Sci 2002; 24(3):111-6.
Jahangard-Rafsanjani Z, Javadi M, Torkamandi H, Alahyari S, Talasaz A, Gholami K. The Evaluation of Albumin Utilization in a Teaching University Hospital in Iran. IJPR 2011; 10(2):385-390.
Aramwit P, Kasettratat N. Evaluation of serum albumin utilization in inpatient at a private hospital in Bangkok. Yakugaku Zasshi 2004; 124 (9):631-4.
Vargas E, de Miguel V, Portolés A, et al. Use of albumin in two Spanish university hospitals. Eur J Clin Pharmacol 1997; 52(6):465-70.
Ferrier L, Torner P, Verry A. Connaissance des indications et des motifs de prescription des albumines au Centre Hospitalier de Sens. Le Pharmacien Hospitalier 1996; 31 (126):15-23.
Wisniewski S, WoronoffLemsi MC, Neidhart M. Albumineet solutions de remplissage au Centre Hospitalier Universitaire de Besançon. Le Pharmacien Hospitalier 1995; 30(120):17- 24.
Debrix I, Combeau D, Stephan F, Benomar A, Becker A. Clinical practice guidelines for the use of albumin: results of a drug use evaluation in a Paris hospital. Pharm World Sci 1999; 21(1):11-6.
Natsch S, vanLeeuwen SJ, de Jong R, Hekster YA. Use of albumin in intensive care unit patients--is continuous quality assessment necessary?. J Clin Pharm Ther 1998; 23(3):179-83.
Doweiko JP, Nompleggi DJ. Use of albumin as a volume expander. JPEN 1991; 15: 484-7.
|Issue||Vol 1, No 4 (Autumn 2013)|
|Drug Utilization Review Albumin Prescriptions Inappropriate Prescribing|
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