Interventions to Increase Leukocyte Testing during Treatment with Dimethyl Fumarate

Paul A. Heidenreich, Shoutzu Lin, Parisa Gholami, Moore Von R., Muriel L. Burk, Peter A. Glassman, Francesca E. Cunningham and Anju Sahay
Additional contact information
Paul A. Heidenreich: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
Shoutzu Lin: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
Parisa Gholami: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
Moore Von R.: Veterans Affairs Center for Medication Safety Pharmacy Benefits Management Services, Hines, IL 60141, USA
Muriel L. Burk: Veterans Affairs Center for Medication Safety Pharmacy Benefits Management Services, Hines, IL 60141, USA
Peter A. Glassman: Veterans Affairs VA Pharmacy Benefits Management Services, Washington, DC 20004, USA
Francesca E. Cunningham: Veterans Affairs Center for Medication Safety Pharmacy Benefits Management Services, Hines, IL 60141, USA
Anju Sahay: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA

IJERPH, 2021, vol. 18, issue 19, 1-7

Abstract: 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%, p = 0.011) and provider education increased the rate by 9% (95% CI 0.6 to 18%, p = 0.037). The WBC monitoring rate increased by 3.8% for each additional intervention used (95% CI 1.2–6.4%, p = 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.

Keywords: outcome assessment; health care; clinical pharmacy information systems; pharmacy services; multiple sclerosis; psoriasis; United States Department of Veterans Affairs (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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