Impact of an innovative blood factor stewardship program on drug expense and patient care.
OBJECTIVE
An innovative pharmacist-led program to improve prescribing, dosing, and monitoring of clotting factor therapy within a large health system is described.


CONCLUSIONS
In an initiative to optimize patient outcomes and control costs associated with the use of clotting factor concentrates, the pharmacy department at University of North Carolina Medical Center (UNCMC) led the development of a "factor stewardship program" in collaboration with UNCMC hematologists. Key steps in program development and implementation included (1) selection of one formulary product within each clotting factor class, (2) establishment of guidelines on blood factor prescribing, order review, compounding, and administration, and (3) initial and ongoing education of pharmacy, nursing, and medical staff. As part of the program, a designated pharmacist rounds with hematologists daily, recommending treatment plan modifications and dosage adjustments as appropriate. Now in its fifth year, the stewardship program has enabled consistent pharmacist oversight of all aspects of clotting factor use and enhanced transitions-of-care coordination. Through optimization of product selection, dosing regimens, and infusion frequencies, the number of blood factor doses in fiscal year 2013 was reduced by 45% from the prior year despite a 22% increase in the volume of treated patients; in patients with hemophilia A, re-admissions due to bleeding episodes have declined. During the four-year period ending in July 2014, estimated cost savings attributable to the stewardship program exceeded $4 million annually.


CONCLUSIONS
Implementation of the UNCMC stewardship program has led to improved outcomes in patients receiving clotting factor concentrates, with significant institutional cost savings.
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy. lindsey.amerine@unchealth.unc.edu
Lindsey B
LB
Amerine
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
Sheh-Li
SL
Chen
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
Rowell
R
Daniels
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
Nigel
N
Key
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
Stephen F
SF
Eckel
Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director of Pharmacy, University of North Carolina (UNC) Medical Center, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill. Sheh-Li Chen, Pharm.D., BCOP, is Clinical Specialist, Hematology/Oncology, UNC Medical Center. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Medical Center, and Executive Associate Dean of Clinical Practice, UNC Eshelman School of Pharmacy. Nigel Key, M.B., Ch.B., FRCP, is Chief, Section of Hematology, Division of Hematology/Oncology, UNC Medical Center, and Professor, UNC School of Medicine, Chapel Hill. Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, FCCP, is Associate Director of Pharmacy, UNC Medical Center, and Clinical Associate Professor, UNC Eshelman School of Pharmacy. Scott W. Savage, Pharm.D., M.S., is Associate Director of Pharmacy, UNC Health Care, and Assistant Professor of Clinical Education, UNC Eshelman School of Pharmacy.
Scott W
SW
Savage
D000046:Academic Medical Centers; D016527:Drug Costs; D015942:Factor VIIa / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D009657:North Carolina; D019982:Organizational Case Studies; D005791:Patient Care / Q000592:standards*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role; D058996:Quality Improvement / Q000458:organization & administration*; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa