Justification for initiating patiromer when restricted by prior authorization and clinical guidance in a US health care system
Notice bibliographique
Résumé
BACKGROUND: In the Veterans Health Administration, patiromer is a formulary medication restricted by prior authorization and criteria-for-use (CFU). Historically, patiromer approval was restricted by step therapy, requiring prescribers to trial sodium polystyrene sulfonate (SPS). OBJECTIVE: To describe clinical scenarios leading to patiromer initiation by characterizing patient experience with primary hyperkalemia treatment modalities, especially SPS. METHODS: All veterans who initiated patiromer between January 1, 2016, and February 28, 2021, with chronic kidney disease and dispensed SPS during the 3 months preceding patiromer were included. A structured chart-review process was used to abstract prior authorization drug request notes to characterize patiromer approval and patient experience with primary pharmacotherapy. Results were reported with descriptive frequencies and proportions. RESULTS: Three hundred thirty-one veterans met inclusion criteria. Primary justification for patiromer initiation included continuation of patiromer initiated outside the Veterans Health Administration or during inpatient stay (5.7%) and SPS inventory shortage (25.4%). CFU justification was mentioned in 83.7% of notes and, among those with CFU justification, SPS treatment was documented in 68.7%. Clinician statements indicating that SPS was ineffective occurred in 65 (41.7%) and statements of safety concerns (either observed or potential) in 37 (23.7%) veterans. CONCLUSIONS: Patiromer approval is multifactorial, and clinicians often opted to avoid long-term SPS use because of safety concerns, lack of consistent availability, and concerns about its appropriateness for longterm hyperkalemia management. DISCLOSURES: Drs Patel and Sauer received funding from Otsuka Canada Pharmaceutical Inc. to study the use of patiromer in the VHA. This material is the result of work supported with resources and the use of facilities at the VA Salt Lake City Health Care System. The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. Drs Qualls and Pinnell are supported by the VA Advanced Fellowship Program in Medical Informatics with the Office of Academic Affiliations. This work was funded through a partnered research mechanism. Otsuka Canada Pharmaceutical Inc. was not involved in development or review of this manuscript.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».