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Biomedical subjects

J D Grabenstein

Publications and source records attributed to J D Grabenstein.

At least 19 recordsLinked to original sources
PubMed1992

Community pharmacists as immunization advocates. Cost-effectiveness of a cue to influenza vaccination.

To assess the cost-effectiveness of a cue to influenza vaccination provided by community pharmacists, a decision tree was constructed of the consequences of implementing a pharmacy-based vaccine-advocacy program, based on experience gained in an experiment involving three community pharmacies in Durham County, North Carolina. The model used morbidity and mortality assumptions derived from the infectious-disease literature and cost assumptions based on 1990-91 Medicare Part A and Part B reimbursement costs. This analysis suggests that if Medicare reimbursed pharmacists for advising 100,000 patients at risk to accept influenza vaccine through vaccine-advocacy messages, for an apparent expenditure of $110,000, the increased rate of influenza vaccinations would avert 139 hospitalizations and 63 deaths, and actually yield Medicare a net savings of $280,588. These calculations probably underestimate the benefit to society of a pharmacy-based vaccine-advocacy program, because only direct costs to the single government agency were computed and no cost was attributed to death or lost earnings.

Aged↗
PubMed1992

Pharmacoepidemiology and military medical automation: opportunity for excellence.

Fielding of the Composite Health Care System (CHCS) brings an unparalleled opportunity for medical research. This sophisticated automated medical record system promises pharmacoepidemiologic research of a quality and quantity never before possible. Pharmacoepidemiology provides answers about the validity of beneficial and adverse drug events and aids in individualizing drug therapy. When CHCS eventually encompasses an estimated 9.1 million patients at 166 military hospitals and 588 clinics around the world, it will provide a database capable of supporting sophisticated automated research. In addition to the unprecedented size of this resource, advantages of pharmacoepidemiology performed with the CHCS database include integration of inpatient and outpatient care records, the completeness of prescription and medical records, and the wide socioeconomic spectrum covered in a defined population. Limitations and potential biases of such a database include separate drug formularies at each medical treatment facility, only limited information about nonprescription drug use and single-dose drug orders in clinics, and the mobility of military service members and their families. Pharmacoepidemiology is a tool that will benefit individual members of the military family, as well as advancing the sciences of pharmacy and medicine. Using the CHCS database for this form of research is in the best tradition of military medical research.

Attitude to Health↗
PubMed1990

Drug interactions involving immunologic agents. Part II. Immunodiagnostic and other immunologic drug interactions.

This two-part review addresses pharmacists' need for information about immunologic drug interactions. Reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents are widely dispersed and, therefore, difficult to access. In the conclusion of this two-part article, immunodiagnostic drug interactions as well as interactions involving interferons and other biologic-response modifiers are discussed, as are epinephrine interactions that affect treatment of immunologic-induced anaphylaxis. Host factors of groups and individuals relating to the clinical significance of proposed interactions are covered, such as those involving influenza vaccine with theophylline, warfarin, or phenytoin, and other combinations. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and further assess known interactions.

Drug Interactions↗
PubMed1990

A comparison of drug products available in Germany and the United States.

Health-care professionals practicing with the U.S. European Command frequently encounter drug products of their host nation. Confusion about the identity or use of these medications can slow emergency treatment or mislead the medical management of patients. This article compares drug products available in the Federal Republic of Germany (FRG) with those of the United States of America. Differences in nomenclature used for generic drug names are described, as well as prescription practices unique to the FRG, such as unusual drug combinations, additional dosage forms, and divergent labeling practices. Military pharmacies are effective resources for translation of host nation drug products.

Dosage Forms↗
PubMed1990

Pharmacoepidemiologic program for identifying patients in need of vaccination.

The feasibility of identifying candidates for vaccination by analyzing patients' use of prescribed drugs as recorded in a computerized database was investigated. Pharmacists at a 45-bed hospital serving U.S. Armed Forces in Germany developed a list of drugs used to treat patients with diagnoses that warrant influenza or pneumococcal pneumonia vaccination. In December 1988 and April 1989, the facility's pharmacy database was searched for patients who had received the infection-risk-indicating drugs during September 1, 1988-March 30, 1989. Medical records of patients identified were screened to verify the indications for vaccination. Patients at risk were sent letters and prescriptions written by a pharmacist to inform and remind them of their need for vaccination. Of 109 patients for whom records were screened, 80 (73.4%) had valid indications for immunization. Of these 80 patients, 48 (60%) accepted the invitation to be immunized. The 80 patients in need of vaccination received 151 individual prescriptions; 77 doses (51%) were administered to 48 patients. Screening by pulmonary, cardiovascular, and hypoglycemic drug use identified the largest numbers of patients in need of vaccination, as did age over 64 years. Patients with more than one risk factor for infection were significantly more likely to accept vaccination than patients with only one risk factor. Pharmacoepidemiologic programs can help pharmacists to fulfill their role as advocates of immunization.

Drug Prescriptions↗
PubMed1990

Drug interactions involving immunologic agents. Part I. Vaccine-vaccine, vaccine-immunoglobulin, and vaccine-drug interactions.

Information about immunologic drug interactions is needed by pharmacists to make rational drug-use decisions. Previously, reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents were widely dispersed. In this two-part review article, over 50 individual and categorical interactions are described, as are dozens of vaccine-vaccine and vaccine-immunoglobulin, and vaccine-drug interactions are reviewed in this first part. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and to further assess known interactions.

Drug Interactions↗
PubMed1989

Incidence of anaphylactic self-treatment in an outpatient population.

Insect-allergic and food-allergic patients with a history of previous anaphylactic reactions were retrospectively and prospectively evaluated for incidence of self-administration of epinephrine or antihistamines. Participants were prescribed either Ana-KitR or Epi-PenR dosage forms. In 33 patients, 82 incidents were noted during 1,252 patient-months, an average of 0.78 incidents per patient-year (PPY). A mean of 0.38 epinephrine uses PPY was recorded, ranging from 0 to 2.82 doses PPY. Antihistamine uses averaged 0.69 PPY, ranging from 0 to 4.47 doses PPY. Antihistamines alone quelled reactions in 13 of 17 incidents involving Ana-Kits. Food-allergic patients were more likely to self-medicate, with 1.93 anti-allergic drug uses PPY, compared with 0.49 uses PPY for insect-allergic patients. Six of 22 insect-related epinephrine uses occurred during winter months. No statistically significant difference was noted between drug administration rates determined retrospectively and prospectively.

Anaphylaxis↗
PubMed1986

Comprehensive immunization delivery in conjunction with influenza vaccination.

All patients and employees presenting for influenza A and B vaccination were studied for the need for other immunizations or tests, based on criteria of the Immunization Practices Advisory Committee. More than 72% of patients and employees needed at least one other vaccine or test. During a 4 1/2-month period, 1,353 doses of influenza virus vaccine, bivalent, types A and B, were prescribed. Health care providers ordered doses of diphtheria and tetanus toxoids (adult) for 36.8% of these recipients, pneumococcal vaccine, polyvalent 23, for 42.1%, and a tuberculin skin test for 36.3%. Determinations of hepatitis B titers or hepatitis B vaccine doses were ordered for 140 individuals. Patients older than 60 years needed additional immunizations with greater frequency. Rates of delayed adverse reactions (35.9%) and subsequent self-medication (11.7%) were recorded. The systemic adverse reaction rate was 17.3%. Annual influenza vaccination programs are valuable public health opportunities to determine immunizations needed by patients who might not otherwise receive a comprehensive, individualized review of the status of their immunization protection.

Adolescent↗
PubMed1985

A comprehensive allergen extract monograph with advice for the patient.

Interest in increased patient education regarding medications they receive is gathering momentum. An historical overview is provided as well as summaries of available patient information resources. To date little such information has been available for patients receiving immunotherapy with allergen extracts. A comprehensive draft monograph driven from multiple sources for the various products available is proposed, as well as suggested advice for patients. Comments and suggestions for revision are solicited, prior to proposed inclusion in a national patient information publication.

Allergens↗
PubMed1985

Operation of an allergen-extract pharmacy.

The quality control (QC) and quality assurance (QA) systems for a military allergen-extract pharmacy are described. The United States Army Allergen Extract Laboratory (USAAEL) provides diagnostic and therapeutic allergen-extract materials to military personnel throughout the world. More than 40,000 individualized prescriptions are compounded annually. The staff is composed of one pharmacist, 16 medical technicians, and four clerical, two inventory, and three supervisory personnel. Each prescription takes about one man-hour to prepare. The technicians are trained in aseptic technique, allergen-extract compounding, and the diagnosis and treatment of allergies during an eight-week program. Following a physician-allergist's evaluation of a patient, a prescription is written with a formula itemizing the specific allergen components, their relative concentrations, and a treatment schedule. Patient profile cards are kept on every patient. A complete record of patient, prescriber, demographic data, allergen formula, treatment schedule, lots, and initials of personnel responsible at each step allow a thorough assessment for QC and QA. The identity and volume of each allergen in every prescription are checked twice. A multitiered QC system is used to identify problems and errors. A QA and QC assessment was conducted on more than 18,000 prescriptions received during a six-month period. More than 99% of all known errors were discovered before the prescriptions were dispensed. Allergen-extract prescriptions must be accurate, precise, and reproducible to be effective and to avoid adverse reactions. Pharmacists can play a vital role in ensuring the optimal quality of diagnostic and therapeutic allergen extracts.

Allergens↗