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Thromb Res. 2017 Dec;160:109-113. doi: 10.1016/j.thromres.2017.10.012. Epub 2017 Oct 21.

Exploring the impact of route of administration on medication acceptance in hospitalized patients: Implications for venous thromboembolism prevention.

Author information

1
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: vpopool1@jhmi.edu.
2
School of Pharmacy, The University of Maryland Baltimore, Baltimore, MD, United States. Electronic address: ftavakoli@umaryland.edu.
3
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States. Electronic address: blau2@jhmi.edu.
4
Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States. Electronic address: mlankie2@jhu.edu.
5
School of Pharmacy, The University of Maryland Baltimore, Baltimore, MD, United States; Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: pross5@jhmi.edu.
6
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: pkraus2@jhmi.edu.
7
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: dshaffe1@jhmi.edu.
8
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States; Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: dhobson1@jhmi.edu.
9
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: jaboagy1@jhmi.edu.
10
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: nfarrow1@jhmi.edu.
11
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: ehaut1@jhmi.edu.
12
The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States; Division of Hematology, Departments of Medicine and Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: mstreif@jhmi.edu.

Abstract

BACKGROUND:

Non-administration of venous thromboembolism (VTE) prophylaxis contributes to preventable patient harm. We hypothesized that non-administration would be more common for parenteral VTE prophylaxis than oral infectious disease or cardiac prophylaxis or for treatment medications. The primary study goal was to determine if non-administration of parenteral VTE prophylaxis is more frequent than other prophylactic or treatment medications.

METHODS:

In this retrospective cohort study of consecutive admissions we used descriptive statistics and risk ratios (RR) to compare the number of non-administered doses of VTE prophylaxis, oral infectious disease and cardiovascular prophylaxis and treatment medications. To quantify the influence of demographic and clinical characteristics on non-administration, we estimated incidence rate ratios from Poisson regression models.

RESULTS:

645 patients were admitted from July 1, 2014 through March 31, 2015. Median age was 52years (Interquartile range 43-57) and 365 (56.6%) were male. Subcutaneous VTE prophylaxis doses were not administered nearly 4-fold more frequently than oral infectious disease and cardiovascular prophylaxis (RR=3.93; 95% CI 3.36-4.59) and 3-fold more frequently than treatment medications (RR=3.06; 95% CI 2.91-3.22). Ninety percent of non-administered doses of VTE prophylaxis were refused. Risk factors for non-administration included younger age (age 18-35years), male sex, uninsured status, HIV-positivity and high VTE risk status.

CONCLUSIONS:

Subcutaneous VTE prophylaxis is not administered more frequently than oral infectious diseases or cardiac prophylaxis and treatment medications. These data suggest that availability of an oral medication could improve the effectiveness of VTE prophylaxis in real world settings.

KEYWORDS:

Medication adherence; Patient safety; Prophylaxis; Venous thromboembolism

PMID:
29149706
DOI:
10.1016/j.thromres.2017.10.012
[Indexed for MEDLINE]

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