The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.
Myelosuppression monitoring after immunomodulator initiation in veterans with inflammatory bowel disease: a national practice audit
Version of Record online: 14 OCT 2012
Published 2012. This article is a US Government work and is in the public domain in the USA.
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 11-12, pages 1049–1056, December 2012
How to Cite
Hou, J. K., Kramer, J. R., Richardson, P., Sansgiry, S. and El-Serag, H. B. (2012), Myelosuppression monitoring after immunomodulator initiation in veterans with inflammatory bowel disease: a national practice audit. Alimentary Pharmacology & Therapeutics, 36: 1049–1056. doi: 10.1111/apt.12075
- Issue online: 7 NOV 2012
- Version of Record online: 14 OCT 2012
- Manuscript Accepted: 16 SEP 2012
- Manuscript Revised: 12 SEP 2012
- Manuscript Received: 20 AUG 2012
- Aptalis pharmaceuticals
- American College of Gastroenterology Junior Faculty Development Award
- Department of Veterans Affairs
- Veterans Health Administration
- Health Services Research and Development Service. Grant Number: MRP05-305
Immunomodulator medications (IMM) play a vital role in the care of patients with inflammatory bowel disease (IBD). IBD practice guidelines recommend myelosuppression monitoring after initiation of IMM.
To identify adherence rates and predictors of myelosuppression monitoring after IMM initiation in a large practice setting.
We identified a national cohort of VA users with IBD for the fiscal years 2003–2009 using the Veterans Affairs administrative datasets. Subjects with filled prescriptions for IMM were included. The primary endpoint was the proportion of subjects who had a white blood cell (WBC) test completed within 90 days of the IMM index date. Determinants of myelosuppression monitoring were identified by univariate and multivariate analyses.
A total of 6045 unique IBD patients were identified with filled IMM prescriptions. Overall, only 57% of subjects completed a WBC test within 90 days of IMM index date. Monitoring rates increased over time, from 48% in 2003 to 75% in 2009. There was variability of monitoring rates by facility, ranging from 0 to 83%. In multivariate analyses, older age at IMM index date was associated with a lower rate of monitoring. Frequency of VA encounters and IMM index date were associated with increased rates of myelosuppression monitoring.
Monitoring for myelosuppression among veterans with inflammatory bowel disease after immunomodulator medications initiation is low with wide variability based on facility. This may reflect a low quality of care among veterans with IBD. Provider- and system-wide interventions are needed to improve adherence and reduce variability of immunomodulator medications monitoring across facilities.