title: Implementation of a therapeutic-interchange clinic for HMG-CoA reductase inhibitors.
abstract: A therapeutic-interchange clinic for statins is described. In 1999, the Department of Defense mandated the use of cerivastatin and simvastatin as the formulary statins in all military health care facilities by April 2000. Cerivastatin was the preferred agent; the goal was to use this agent in 60-65% of all patients. Walter Reed Army Medical Center developed a voluntary therapeutic-interchange clinic for patients receiving statins. Goals included facilitating the rapid switching of patients to the formulary statins, maximizing the use of the preferred agent, maintaining or improving lipid control, monitoring safety, determining costs, educating patients about their treatment, and documenting satisfaction with the clinic. Written educational materials were prepared, an algorithm for statin conversion was created, and laboratory tests were performed, among other measures. Between January and April 2000, 1356 patients were seen by the therapeutic-interchange clinic; of these, 942 agreed to have the efficacy and safety of their therapy monitored by the clinic. Before the formulary change, the most commonly prescribed statins were atorvastatin (44% of patients) and pravastatin (42%). Under the conversion policy, 96% of patients received cerivastatin and 4% simvastatin. The percentage of patients achieving their targeted low-density-lipoprotein cholesterol concentration increased from 65% to 75%. The policy saved an average of $115 per patient in the first year. Most patients were satisfied with the clinic, but only 36% of providers were satisfied. Cerivastatin was withdrawn from the market in August 2001; simvastatin became the only formulary statin. A therapeutic-interchange clinic at a military medical center provided an efficient means of switching a large number of patients to alternative statin therapy, monitoring the outcomes, and individualizing patient care.
authors.affiliation: Pharmacy Clinical Support Service, Department of Pharmacy, Walter Reed Army Medical Center (WRAMC), Washington, DC, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grace
authors.forename: Jennifer
authors.initials: J
authors.lastname: Swiecki
authors.forename: Richard
authors.initials: R
authors.lastname: Hyatt
authors.forename: Henry
authors.initials: H
authors.lastname: Gibbs
authors.forename: David L
authors.initials: DL
authors.lastname: Jones
authors.forename: Munazza
authors.initials: M
authors.lastname: Sheikh
authors.forename: John
authors.initials: J
authors.lastname: Spain
authors.forename: Kent W
authors.initials: KW
authors.lastname: Maneval
authors.forename: Rebecca
authors.initials: R
authors.lastname: Viola
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration; D005260:Female; D006772:Hospitals, Military / Q000191:economics / Q000458:organization & administration; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D011725:Pyridines / Q000191:economics / Q000627:therapeutic use; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011725:Pyridines; D019821:Simvastatin; C086276:cerivastatin