Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Int J Environ Res Public Health. 2021 Sep 30;18(19):10312. doi: 10.3390/ijerph181910312.
Dimethyl fumarate (DMF), a treatment for multiple sclerosis, may cause leukopenia and infection. Accordingly, periodic white blood cell (WBC) monitoring is recommended. We sought to evaluate the US Department of Veteran Affairs' safety program which provides facilities with a list of patients prescribed DMF therapy without a documented white blood cell count (WBC). We identified 118 sites with patients treated with DMF from 1 January 2016 through 30 September 2016. Each site was asked if any of seven interventions were used to improve WBC monitoring (academic detailing, provider education without academic detailing, electronic clinical reminders, request for provider action plan, draft orders for WBC monitoring, patient mailings, and patient calls). The survey response rate was 78%. For the 92 responding sites (78%) included sites (1115 patients) the mean rate of WBC monitoring was 54%. In multivariate analysis, academic detailing increased the rate by 17% (95% CI 4 to 30%, = 0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, = 0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2-6.4%, = 0.005). Interventions focused on the physician, including academic detailing, were associated with improved WBC monitoring for patients at risk for leukopenia from DMF treatment.
富马酸二甲酯（DMF）是一种多发性硬化症的治疗药物，可能导致白细胞减少症和感染。因此，建议定期监测白细胞（WBC）。我们评估了美国退伍军人事务部的安全计划，该计划向医疗机构提供开处方使用 DMF 疗法但未记录白细胞计数（WBC）的患者名单。我们确定了 2016 年 1 月 1 日至 2016 年 9 月 30 日期间使用 DMF 治疗的 118 个治疗地点。每个地点都被问及是否使用了以下七种干预措施中的任何一种来改善 WBC 监测：学术细化、无学术细化的提供者教育、电子临床提醒、要求提供者行动计划、WBC 监测草案命令、患者邮件和患者电话。调查回复率为 78%。对于 92 个做出回应的地点（78%）包括了（1115 名患者），WBC 监测的平均比率为 54%。在多变量分析中，学术细化使比率增加了 17%（95%CI 4-30%， = 0.011），而提供者教育使比率增加了 9%（95%CI 0.6-18%， = 0.037）。每增加一种干预措施，WBC 监测率增加 3.8%（95%CI 1.2-6.4%， = 0.005）。针对医生的干预措施，包括学术细化，与改善接受 DMF 治疗有白细胞减少症风险的患者的 WBC 监测相关。
