Implementation of a herpes zoster immunization program in an outpatient hospital-based pharmacy.

Background: Administration of the recombinant zoster vaccine (RZV) in an ambulatory clinic visit is not covered by Medicare, and the pharmacy at Tufts Medical Center (TMC) had not previously offered immunizations, leaving clinicians to instruct their patients to receive RZV at outside pharmacies without close follow-up.

Objective: Improve immunization access by standardizing administration of RZV for eligible patients at TMC.

Practice Description: TMC is an academic medical center that serves a vast patient population.

Prevalence of low high-density lipoprotein cholesterol in patients with documented coronary heart disease or risk equivalent and controlled low-density lipoprotein cholesterol.

Current guidelines identify low-density lipoprotein (LDL) cholesterol as the primary target for cardiovascular prevention but also recognize low high-density lipoprotein (HDL) cholesterol as an important secondary target. This study was conducted to determine the prevalence of low HDL cholesterol in a contemporary ambulatory high-risk population across various LDL cholesterol levels, including patients taking statins. Screening of 44,052 electronic medical records from a primary care practice identified 1,512 high-risk patients with documented coronary heart disease (CHD) or CHD risk equivalents.

Extent to which accepted serum lipid goals are achieved in a contemporary general medical population with coronary heart disease risk equivalents.

This study examined lipid levels and the use of lipid-altering drugs in a contemporary general medical population without documented coronary heart disease (CHD) but with CHD risk equivalents. On the basis of present national guidelines, the following lipid values (in milligrams per deciliter) were considered optimal for this population: low-density lipoprotein cholesterol <100, high-density lipoprotein (HDL) cholesterol >or=40 in men and >or=50 in women, and non-HDL cholesterol <130 if triglycerides are >or=200. Of 44,052 active patients screened, 877 with CHD risk equivalents as defined by the Adult Treatment Panel III guidelines were identified.

Evaluating the nondrug costs of formulary coverage restrictions.

Purpose: Clinicians often are required to switch prescribed therapy for their patients in response to health plan initiatives for controlling drug expenditures. To explore the effect of these initiatives, we sought clinicians' feedback regarding their practices and processes for switching patients' medications to accommodate insurance coverage.

Design: Self-administered Intranet-based survey of clinicians at an urban, tertiary-care hospital.