Underutilization of Medications in Hospitals

For hospital care, three broad classifications of studies were identified: on treatment of acute coronary syndromes, on antibiotic prophylaxis for surgical patients, and on thromboembolic prophylaxis for surgical patients (see Table 3-11). Seven studies addressed acute myocardial infarction. Within the first 24 hours of hospitalization for a myocardial infarction, 85–93 percent had received aspirin (Sanborn et al., 2004; Granger et al., 2005; Roe et al., 2005), and 66–78 percent beta-blockers (Sanborn et al., 2004; Granger et al., 2005; Roe et al., 2005). Among patients discharged with a diagnosis of acute myocardial infarction, aspirin was prescribed for 53–93 percent of ideal candidates (those with no known contraindication), beta-blockers for 53–83 percent of ideal candidates, and angiotensin converting enzyme (ACE) inhibitors for 59–83 percent of ideal candidates (Alexander et al., 1998; Petersen et al., 2001, 2003; Krumholz et al., 2003; Sanborn et al., 2004; Granger et al., 2005; Roe et al., 2005). Rates of prophylaxis for bacterial infections among surgical patients ranged from 70 to 98 percent (Heineck et al., 1999; Vaisbrud et al., 1999; Gupta et al., 2003; van Kasteren et al., 2003; Bedouch et al., 2004; Quenon et al., 2004). Rates of thromboembolic prophylaxis varied greatly—from 5 to 81 percent (Ageno et al., 2002; Ahmad et al., 2002; Aujesky et al., 2002; Campbell et

TABLE 3-11 Underutilization of Medications in Hospitals

Patients discharged with diagnosis of acute myocardial infarction

Percentage of patients given aspirin within 24 hours of hospitalization

85–93 (3 studies)

 

Percentage of patients prescribed aspirin at discharge

53–93 (6 studies)

 

Percentage of patients given beta-blockers within 24 hours of hospitalization

66–78 (3 studies)

 

Percentage of patients prescribed beta-blockers at discharge

53–83 (6 studies)

 

Percentage of patients prescribed angiotensin converting enzyme (ACE) inhibitors at discharge

51–73 (6 studies)

Rates of antibiotic prophylaxis in surgical studies

Percentage of procedures for which patients prescribed antibiotics

70–98 (6 studies)

Rates of thromboembolic prophylaxis in surgical studies

Percentage of procedures for which thromboembolic prophylaxis carried out

5–90 (9 studies)



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