Human Albumin Utilization in Patients Admitted to a University-affiliated Hospital in Iran
-
Afshin Gharekhani
,
Hamid Noshad
,
Soheil Teimouri
,
Haleh Rezaee
,
Abasad Gharedaghi
,
Sepideh Rahigh-Aghsan
Abstract
Background: As an essential human protein and an expensive biological drug, albumin is, in several cases, prescribed without an appropriate indication. This study determined the compatibility of albumin administration with the current standard protocols in a university-affiliated hospital in Iran.Methods: A total of 151 patients admitted to a university-affiliated hospital in Iran from June 22, 2016, to 2017 participated in the present cross-sectional study. The demographic information of the patients (age, gender, and ward), the reason for albumin prescription, and details of its use were recorded (the total amount prescribed, the duration of albumin therapy, dosage, or frequency). The compliance of the albumin administration with the current guidelines (appropriate vs. inappropriate) was checked and confirmed by a senior clinical pharmacist.Results: Sixty-six (43.7%) patients were female and 85 (56.3%) were male. The Mean±SD age of the patients was 53.98±25.34 years. Among the patients receiving albumin, patients with infectious diseases, burn injuries, and operations were the most frequent cases. Generally, 171 vials were administered inappropriately during the study. Also, the inappropriate administration of albumin was most common among infectious disease specialists, followed by internists and general surgeons, resulting in $35878.5 wastage (each vial is around $33.5 in Iran).Conclusion: The logical administration of albumin should be based on the appropriate guidelines and clinical needs of the patients. In a majority of the cases, albumin was prescribed inappropriately and at an alarming rate. These results indicate the need for educational programs and appropriate policies for physicians prescribing albumin.
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2. Yinnon AM, Skorohod Y, Schlesinger Y, Greenberg A. Cefuroxime utilization evaluation: Impact of physician education on prescribing patterns. Isr Med Assoc J. 2000; 2(3):187-91.
3. Hammerman A, Greenberg A, Yinnon AM. Drug use evaluation of ciprofloxacin: Impact of educational efforts on appropriateness of use. J Clin Pharm Ther. 1997; 22(5-6):415-20. [DOI:10.1111/j.1365-2710.1997.tb00026.x] [PMID]
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5. Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: A critical analysis of the experimental literature. Milbank Q. 2005; 83(4):1-48. [DOI:10.1111/j.1468-0009.2005.00435.x] [PMCID]
6. Sakhaiyan E, Hadjibabaie M, Gholami K, Fahimi F, Shamshiri AR, Alimoghaddam K, et al. Drug utilization evaluation of imipenem in patients undergoing bone marrow transplantation. Int J HematolOncol Stem Cell Res. 2009; 3(2):10-3.
7. World Health Organization (WHO). Promoting rational use of medicines: Core components. Promoting rational use of medicines: Core components. Geneva: World Health Organization; 2002.
8. Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G, Italian Society of Transfusion Medicine and Immunohaematology (SIMTI). Recommendations for the use of albumin and immunoglobulins. Blood Transfus. 2009; 7(3):216-34. [DOI:10.2450/2009.009409] [PMID] [PMCID]
9. Mirici-Cappa F, Caraceni P, Domenicali M, Gelonesi E, Benazzi B, Zaccherini G, et al. How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure. World J Gastroenterol. 2011; 17(30):3479-86. [DOI:10.3748/wjg.v17. i30.3479] [PMID] [PMCID]
10. Colgan K, Moody ML, Witte K. Responsible use of blood products in response to supply and demand. Am J Health Syst Pharm. 2000; 57(22):2094-8. [DOI:10.1093/ajhp/57.22.2094] [PMID]
11. King WS, Roland K, Selin S, Chipperfield K, Morrison D. Introduction of guidelines for the use of albumin and the effect on albumin prescribing practices in British Columbia. Bull Vancouver Med Assoc. 2012; 54(1):34-8.
12. Caironi P, Langer T, Gattinoni L. Albumin in critically ill patients: The ideal colloid? Curr Opin Crit Care. 2015; 21(4):302-8. [DOI:10.1097/ MCC.0000000000000223] [PMID]
13. Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J, et al. Albumin administration in the acutely ill: What is new and where next? Crit Care. 2014; 18(4):1-10 [DOI:10.1186/cc13991] [PMID] [PMCID]
14. Margarson MP, Soni NC. Effects of albumin supplementation on microvascular permeability in septic patients. J Appl Physiol. 2002; 92(5):2139-45. [DOI:10.1152/japplphysiol.00201.2001] [PMID]
15. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res. 2012; 33(6):702-17. [DOI:10.1097/ BCR.0b013e31825b1cf6] [PMID]
16. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: A systematic review of randomised trials. BMJ. 1998; 316(7136):961-4. [DOI:10.1136/ bmj.316.7136.961] [PMID] [PMCID]
17. Ofori-Asenso R, Agyeman AA. Irrational Use of Medicines-A Summary of Key Concepts. Pharmacy (Basel). 2016; 4(4):1-13. [DOI:10.3390/pharmacy4040035] [PMID] [PMCID]
18. Farasatinasab M, Amouzegar A, Safari S, Ghanbari B, Darkahian M, Emami S, et al. Albumin utilization evaluation in a major teaching hospital in Iran: Recommendations for guideline development. J Res Pharm Pract. 2018; 7(3):157-63. [DOI:10.4103/jrpp.JRPP_18_4] [PMID] [PMCID]
19. Zolfagharian F, Ghazanfari S, Elyasi S, Iraji P, Saberi MR, VahdatiMashhadian N, et al. Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: An interventional pre-post design study. Int J Clin Pharm. 2017; 39(4):704-11. [DOI:10.1007/ s11096-017-0458-y] [PMID]
20. Vazin A, Karimzadeh I, Karamikhah R, Oveisi Z, Mohseni S, Keykhaee M, et al. Clinical and economical impacts of guideline implementation by the pharmaceutical care unit for high cost medications in a referral teaching hospital. BMC Health Serv Res. 2018; 18(1):815. [DOI:10.1186/s12913-018-3627-3] [PMID] [PMCID]
21. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014; 370(15):1412-21. [DOI:10.1056/ NEJMoa1305727] [PMID]
22. Ala S, Salehifar E, Chalaki V. Evaluation of Albumin Use in a Teaching Hospital. J Mazandaran Unive Med Sci. 2015; 25(129):137-41.
23. Talasaz AH, Jahangard-Rafsanjani Z, Ziaie S, Fahimi F. Evaluation of the pattern of human albumin utilization at a university affiliated hospital. Arch Iran Med. 2012; 15(2):85-7. [PMID]
24. Kazemi Y, Hadavand N, Hayatshahi A, Torkamandi H, Gholami K, Hadjibabaie M, et al. Albumin utilization in a teaching hospital in Tehran: Time to revise the prescribing strategies. Arch Iran Med. 2013; 15(2):127-32.
25. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Patient survival after human albumin administration. Ann Intern Med. 2001; 135(3):149-64. [DOI:10.7326/0003-4819-135-3-20010807000007] [PMID]
26. Shafiee E, Rezaee H, Entezari-Maleki T, Hamishehkar H. The evaluation of albumin use in an Iranian university hospital. Pharm Sci. 2016; 22(3):186-9. [DOI:10.15171/PS.2016.29]
2. Yinnon AM, Skorohod Y, Schlesinger Y, Greenberg A. Cefuroxime utilization evaluation: Impact of physician education on prescribing patterns. Isr Med Assoc J. 2000; 2(3):187-91.
3. Hammerman A, Greenberg A, Yinnon AM. Drug use evaluation of ciprofloxacin: Impact of educational efforts on appropriateness of use. J Clin Pharm Ther. 1997; 22(5-6):415-20. [DOI:10.1111/j.1365-2710.1997.tb00026.x] [PMID]
4. Soumerai SB, Avorn J. Efficacy and cost-containment in hospital pharmacotherapy: State of the art and future directions. Milbank Mem Fund Q Health Soc. 1984; 62(3):447-74. [DOI:10.2307/3349860] [PMID]
5. Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: A critical analysis of the experimental literature. Milbank Q. 2005; 83(4):1-48. [DOI:10.1111/j.1468-0009.2005.00435.x] [PMCID]
6. Sakhaiyan E, Hadjibabaie M, Gholami K, Fahimi F, Shamshiri AR, Alimoghaddam K, et al. Drug utilization evaluation of imipenem in patients undergoing bone marrow transplantation. Int J HematolOncol Stem Cell Res. 2009; 3(2):10-3.
7. World Health Organization (WHO). Promoting rational use of medicines: Core components. Promoting rational use of medicines: Core components. Geneva: World Health Organization; 2002.
8. Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G, Italian Society of Transfusion Medicine and Immunohaematology (SIMTI). Recommendations for the use of albumin and immunoglobulins. Blood Transfus. 2009; 7(3):216-34. [DOI:10.2450/2009.009409] [PMID] [PMCID]
9. Mirici-Cappa F, Caraceni P, Domenicali M, Gelonesi E, Benazzi B, Zaccherini G, et al. How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure. World J Gastroenterol. 2011; 17(30):3479-86. [DOI:10.3748/wjg.v17. i30.3479] [PMID] [PMCID]
10. Colgan K, Moody ML, Witte K. Responsible use of blood products in response to supply and demand. Am J Health Syst Pharm. 2000; 57(22):2094-8. [DOI:10.1093/ajhp/57.22.2094] [PMID]
11. King WS, Roland K, Selin S, Chipperfield K, Morrison D. Introduction of guidelines for the use of albumin and the effect on albumin prescribing practices in British Columbia. Bull Vancouver Med Assoc. 2012; 54(1):34-8.
12. Caironi P, Langer T, Gattinoni L. Albumin in critically ill patients: The ideal colloid? Curr Opin Crit Care. 2015; 21(4):302-8. [DOI:10.1097/ MCC.0000000000000223] [PMID]
13. Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J, et al. Albumin administration in the acutely ill: What is new and where next? Crit Care. 2014; 18(4):1-10 [DOI:10.1186/cc13991] [PMID] [PMCID]
14. Margarson MP, Soni NC. Effects of albumin supplementation on microvascular permeability in septic patients. J Appl Physiol. 2002; 92(5):2139-45. [DOI:10.1152/japplphysiol.00201.2001] [PMID]
15. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res. 2012; 33(6):702-17. [DOI:10.1097/ BCR.0b013e31825b1cf6] [PMID]
16. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: A systematic review of randomised trials. BMJ. 1998; 316(7136):961-4. [DOI:10.1136/ bmj.316.7136.961] [PMID] [PMCID]
17. Ofori-Asenso R, Agyeman AA. Irrational Use of Medicines-A Summary of Key Concepts. Pharmacy (Basel). 2016; 4(4):1-13. [DOI:10.3390/pharmacy4040035] [PMID] [PMCID]
18. Farasatinasab M, Amouzegar A, Safari S, Ghanbari B, Darkahian M, Emami S, et al. Albumin utilization evaluation in a major teaching hospital in Iran: Recommendations for guideline development. J Res Pharm Pract. 2018; 7(3):157-63. [DOI:10.4103/jrpp.JRPP_18_4] [PMID] [PMCID]
19. Zolfagharian F, Ghazanfari S, Elyasi S, Iraji P, Saberi MR, VahdatiMashhadian N, et al. Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: An interventional pre-post design study. Int J Clin Pharm. 2017; 39(4):704-11. [DOI:10.1007/ s11096-017-0458-y] [PMID]
20. Vazin A, Karimzadeh I, Karamikhah R, Oveisi Z, Mohseni S, Keykhaee M, et al. Clinical and economical impacts of guideline implementation by the pharmaceutical care unit for high cost medications in a referral teaching hospital. BMC Health Serv Res. 2018; 18(1):815. [DOI:10.1186/s12913-018-3627-3] [PMID] [PMCID]
21. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014; 370(15):1412-21. [DOI:10.1056/ NEJMoa1305727] [PMID]
22. Ala S, Salehifar E, Chalaki V. Evaluation of Albumin Use in a Teaching Hospital. J Mazandaran Unive Med Sci. 2015; 25(129):137-41.
23. Talasaz AH, Jahangard-Rafsanjani Z, Ziaie S, Fahimi F. Evaluation of the pattern of human albumin utilization at a university affiliated hospital. Arch Iran Med. 2012; 15(2):85-7. [PMID]
24. Kazemi Y, Hadavand N, Hayatshahi A, Torkamandi H, Gholami K, Hadjibabaie M, et al. Albumin utilization in a teaching hospital in Tehran: Time to revise the prescribing strategies. Arch Iran Med. 2013; 15(2):127-32.
25. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Patient survival after human albumin administration. Ann Intern Med. 2001; 135(3):149-64. [DOI:10.7326/0003-4819-135-3-20010807000007] [PMID]
26. Shafiee E, Rezaee H, Entezari-Maleki T, Hamishehkar H. The evaluation of albumin use in an Iranian university hospital. Pharm Sci. 2016; 22(3):186-9. [DOI:10.15171/PS.2016.29]
| Files | ||
| Issue | Vol 4 No 1/2 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Albumin Clinical pharmacist Drug utilization review Inappropriate prescribing | ||
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How to Cite
1.
Gharekhani A, Noshad H, Teimouri S, Rezaee H, Gharedaghi A, Rahigh-Aghsan S. Human Albumin Utilization in Patients Admitted to a University-affiliated Hospital in Iran. JPPM. 2018;4(1/2):19-24.
