All-cause hospitalizations for inflammatory bowel diseases:Can the reason for admission provide information on inpatient resource use?A study from a large veteran affairs hospital

Background:Inflammatory bowel diseases(IBDs) are group of chronic inflammatory illnesses with a remitting and relapsing course that may result in appreciable morbidity and high medical costs secondary to repeated hospitalizations.The study's objectives were to identify the reasons for hospitalization among patients with IBDs,and compare inpatient courses and readmission rates for IBD-related admissions versus non-IBD-related admissions.Methods:A retrospective chart review was performed on all patients with IBD admitted to the Minneapolis Veterans Affairs(VA) Medical Center between September 2010 and September 2012.Results:A total of 111 patients with IBD were admitted during the 2-year study period.IBD flares/complications accounted for 36.9% of the index admissions.Atherothrombotic events comprised the second most common cause of admissions(14.4%) in IBD patients.Patients with an index admission directly related to IBD were significantly younger and had developed IBD more recently.Unsurprisingly,the IBD admission group had significantly more gastrointestinal endoscopies and abdominal surgeries,and was more likely to be started on medication for IBD during the index stay.The median length of stay(LOS) for the index hospitalization for an IBD flare or complication was 4(2–8) days compared with 2(1–4) days for the other patients(P=0.001).A smaller percentage of the group admitted for an IBD flare/complication had a shorter ICU stay compared with the other patients(9.8% vs.15.7%,respectively); however,their ICU LOSs tended to be longer(4.5 vs.2.0 days,respectively,P=0.17).Compared to the other admission types,an insignificantly greater percentage of the group whose index admission was related to an IBD flare or complication had at least one readmission within 6 months of discharge(29% versus 21%; P=0.35).The rate of admission was approximately 80% greater in the group whose index admission was related to an IBD flare or complication compared to the other types of admission(rate ratio 1.8,95% confidence interval 0.96 to 3.4),although this difference did not reach statistical significance(P=0.07).Conclusion:Identifying the reasons for the patients' index admission,IBD flares versus all other causes,may provide valuable information concerning admission care and the subsequent admission history.

Comparison of Amiodarone Compliance Monitoring： Usual Care, Electronic Prescribing Template and Pharmacist-Managed Clinic

Objective： To assess whether adherence to amiodarone monitoring differed pre- and post-amiodarone restriction template and implementation of the pharmacist-managed clinic. Design： This was a retrospective chart review study. Setting： A large, academically-affiliated Veteran Affairs Healthcare System providing primary and tertiary care. Patients： 580 patients were identified as having an active prescription for amiodarone for at least 60 days from January l, 2009 to August 31, 2013 and receiving primary care at the VAAHS （Veterans Affairs Ann Arbor Healthcare System）. Results： Nearly all patients had TSH and LFTs at baseline regardless of study group. Significant associations between baseline rates for CXR, ECG, PFT, and opbthalmologic exams were found, with higher rates in the clinic and template arms compared to usual care. Similar patterns for all monitoring outcome rates were also found for both the 6- and 12-month measures. Conclusions： Patients on amiodarone who are followed by a pharmacist-managed clinic or where a restricted ordering template was used had increased compliance with amiodarone monitoring guidelines compared to usual care. Use of a restricted template may be a reasonable option in place of a pharmacist-managed service.

Assessment of Diabetes Outcomes in VA Patients： A Retrospective Study of a Pharmacist-Run CDM Clinic

We evaluated whether pharmacist or primary care management resulted in a larger reduction in mean AlC and which group resulted in a higher number of patients reaching an AlC goal of 7% or lower. This was a single center, retrospective cohort study at the VA Medical Center in Topeka, KS. We included 198 patients with uncontrolled type 2 diabetes （AlC 〉 9%）. Patients with ≥ 1 outpatient pharmacist visit were included in the interventional group, and patients with only primary care visits were included in the control group. A total of 198 patients were included in the study. Pharmacist management reduced the mean AlC by 2.7% （p = 〈 0.05） and primary care decreased the mean AlC by 2.4% （p = 〈 0.05）. A higher percentage of primary care patients reached the AlC goal of ≤ 7% compared to the pharmacy group at 34.3% and 21.5% （p = 0.107）, respectively. The pharmacist managed and primary care managed groups achieved similar reductions in the mean AlC and for the number of patients reaching the AlC goal,