Black Cameron, Brownlee Thomas, Pasay Darren
, PharmD, ACPR, is with Pharmacy Services, Red Deer Regional Hospital Centre, Alberta Health Services, Red Deer, Alberta.
, BSP, ACPR, is with Pharmacy Services, Red Deer Regional Hospital Centre, Alberta Health Services, Red Deer, Alberta.
Can J Hosp Pharm. 2024 Jan 10;77(1):e3500. doi: 10.4212/cjhp.3500. eCollection 2024.
In select clinical scenarios, IV administration of iron is suitable for management of iron deficiency anemia; however, for most patients, oral administration of iron is the mainstay of treatment. At the Red Deer Regional Hospital Centre, in Red Deer, Alberta, high utilization of IV iron has resulted in limited access to this medication for the treatment of ambulatory patients, as well as significant usage of health care resources.
The primary objective was to compare patient characteristics, specifically pretreatment laboratory test results and previous use of oral iron, among those receiving IV iron therapy in an ambulatory setting before and after implementation of an iron sucrose order set. For secondary objectives, the aforementioned groups were compared with regard to meeting the diagnostic criteria for iron deficiency anemia, with or without pretreatment oral iron or blood transfusion, and the dosing characteristics for IV iron.
A retrospective electronic chart review was performed for ambulatory patients who received IV iron between January 1, 2020, and January 31, 2022.
A total of 436 unique treatment courses were included in the analysis. The following pretreatment laboratory results were observed before and after implementation of the iron sucrose order set: mean hemoglobin 105.8 (standard deviation [SD] 21.9) g/L versus 102.2 (SD 18.5) g/L; mean of mean corpuscular volume (MCV) 82.2 (SD 9.4) fL versus 79.2 (SD 8.9) fL; and median ferritin 7 (interquartile range [IQR] 4-12) μg/L versus 6 (IQR 4-11) μg/L. Only the difference in MCV values was statistically significant ( = 0.001).
The implementation of an iron sucrose order set for ambulatory patients did not have a significant effect on pretreatment laboratory parameters among patients for whom IV iron was prescribed. Further stewardship initiatives could be beneficial in improving the appropriateness of IV iron use.
在特定临床情况下，静脉注射铁剂适用于缺铁性贫血的治疗；然而，对于大多数患者而言，口服铁剂是主要的治疗方法。在加拿大艾伯塔省红鹿市的红鹿地区医院中心，静脉铁剂的高使用率导致门诊患者获得这种药物进行治疗的机会有限，同时也造成了医疗资源的大量使用。
主要目的是比较在实施蔗糖铁医嘱集前后，门诊接受静脉铁剂治疗的患者的特征，特别是治疗前实验室检查结果和先前口服铁剂的使用情况。次要目的是比较上述两组患者在符合或不符合缺铁性贫血诊断标准、有无治疗前口服铁剂或输血情况以及静脉铁剂给药特征方面的差异。
对2020年1月1日至2022年1月31日期间接受静脉铁剂治疗的门诊患者进行回顾性电子病历审查。
分析共纳入436个独特的治疗疗程。在实施蔗糖铁医嘱集前后观察到以下治疗前实验室结果：平均血红蛋白分别为105.8（标准差[SD]21.9）g/L和102.2（SD 18.5）g/L；平均红细胞体积（MCV）均值分别为82.2（SD 9.4）fL和79.2（SD 8.9）fL；铁蛋白中位数分别为7（四分位间距[IQR]4 - 12）μg/L和6（IQR 4 - 11）μg/L。只有MCV值的差异具有统计学意义（P = 0.001）。
为门诊患者实施蔗糖铁医嘱集对开具静脉铁剂处方患者的治疗前实验室参数没有显著影响。进一步的管理措施可能有助于提高静脉铁剂使用的合理性。
