Therapeutic Interchange Practices Among Texas Medical Center Institutions

摘要

Purpose: There has been an increase in therapeutic interchange (TI) practices in institutional settings because of the growing number of "me too" drugs and the desire for hospitals to minimize their formularies' economic impact. The Texas Medical Center (TMC) Clinical Pharmacists Task Force conducted a study to determine TI practices at TMC member institutions. Methods: The task force members who represented a hospital were polled to determine whether their institution participated in a TI process for medication dispensing. Members who provided a positive response were asked to submit a copy of the institution's policy and/or procedure for review. Each policy and procedure was reviewed to determine the therapeutic classes of agents involved in TI, as well as the preferred agents. Results: Of the hospitals involved in the study, 6 reported the presence of policies/procedures for TI practices, and it was found that 3 policies/ procedures were common. There were 5 common therapeutic classes of agents involved in TI at all 6 hospitals. Most endorsed the use of cefoxitin or cefepime as the preferred antimicrobial agent. Famotidine was the preferred H_2 antagonist, and pantoprazole was the recommended proton pump inhibitor. Simvastatin was the approved alternative for beta-hydroxy-beta-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors, and for all requested angiotensin-converting enzyme inhibitors, lisinopril was the recommended formulary agent.Conclusion: Although this project identified some consistency in TI practices, it also recognized inconsistencies in the conversions used for select interchanges; these should be further researched.