Comments on: Evidence-Based Approach to Cutaneous Treatments http://www.aahpm.org/apps/blog/?p=556 Physicians caring for patients with serious illness. Thu, 07 Feb 2013 01:31:00 +0000 http://wordpress.org/?v=2.9.1 hourly 1 By: Jason Kimbrel http://www.aahpm.org/apps/blog/?p=556&cpage=1#comment-59 Jason Kimbrel Sat, 06 Mar 2010 21:11:17 +0000 http://www.awebsource.com/clients/aahpm/blog/?p=556#comment-59 I also attended this session and was very happy to see they used critical drug information skills to evaluate the literature and didn’t just recommend these agents without the supporting evidence. There was this global mention of terms like inexpensive and <$1.00 per dose for some of these products for pain and nausea and vomiting and I would have to disagree. I would remind everyone this may be true for cost of the ingredients, but often retails pharmacies charge compounding fee’s and labor to compound and often lead to much higher prices. I often see much higher costs in the community setting for these products ($2-$5 dollars per dose). I agree 100% with the idea of protocol’s for these products as I find hospices use these as 1st line therapy because it’s easy to administer. I have a couple of concerns with that model. 1) It often leads to an overall higher cost per patient day for the hospice 2) It takes away from the “thought process” of thinking about the sources and causes of nausea and vomiting. There is good data that states if you evaluate the symptoms and likely causes you can often treat nausea/vomiting successfully without having to combine multiple drugs into a gel or supp. I have worked with hospices all around the country and helped them put into place nausea and vomiting protocols combining patient presentation of symptoms and most likely cause and have watch their compound use come down to almost zero with great success and their cost per patient day drop. Jason Kimbrel, Pharm.D., BCPS HospiScript Services Columbus, Ohio I also attended this session and was very happy to see they used critical drug information skills to evaluate the literature and didn’t just recommend these agents without the supporting evidence. There was this global mention of terms like inexpensive and <$1.00 per dose for some of these products for pain and nausea and vomiting and I would have to disagree. I would remind everyone this may be true for cost of the ingredients, but often retails pharmacies charge compounding fee’s and labor to compound and often lead to much higher prices. I often see much higher costs in the community setting for these products ($2-$5 dollars per dose). I agree 100% with the idea of protocol’s for these products as I find hospices use these as 1st line therapy because it’s easy to administer.
I have a couple of concerns with that model. 1) It often leads to an overall higher cost per patient day for the hospice 2) It takes away from the “thought process” of thinking about the sources and causes of nausea and vomiting.
There is good data that states if you evaluate the symptoms and likely causes you can often treat nausea/vomiting successfully without having to combine multiple drugs into a gel or supp. I have worked with hospices all around the country and helped them put into place nausea and vomiting protocols combining patient presentation of symptoms and most likely cause and have watch their compound use come down to almost zero with great success and their cost per patient day drop.

Jason Kimbrel, Pharm.D., BCPS
HospiScript Services
Columbus, Ohio

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