Implementation of a pharmacist-managed clinic for patients receiving erythropoietin-stimulating agents.

PURPOSE The initiation of a pharmacist-managed clinic to ensure appropriate use of erythropoietin-stimulating agents (ESAs) at a Veterans Affairs medical center is described. SUMMARY A drug-use evaluation (DUE) in 2005 showed that ESA therapy met all of the institution's usage criteria in only 2 of 49 patients receiving ESAs. A protocol was developed and approved for pharmacist management of ESA therapy; physicians refer all patients beginning or currently receiving ESAs to a clinic established for pharmacist management of this therapy. The clinic initiated iron therapy when a patient's transferrin saturation (TSAT) was <20% and serum ferritin concentration was <100 ng/ mL, indicating low iron stores. Hemoglobin, TSAT, and ferritin levels at baseline and after four months of clinic management were compared for 35 patients, as were the costs of ESA therapy before and after clinic enrollment. Hemoglobin levels improved significantly within one month, and cost savings were substantial. Six months after clinic implementation, ESA therapy for 27 of 29 patients was in compliance with DUE criteria. CONCLUSION Pharmacist management of patients receiving ESA therapy was effective in improving hemoglobin levels and compliance with criteria for ESA use, and it achieved substantial cost savings.