J ALLERGY CLIN IMMUNOL

VOLUME 125, NUMBER 2

Abstracts AB33

SA

TU

RD

AY

128 Using Electronic Health Record as a Tool to Assess

Adherence to Clinical Practice Parameters for AllergicRhinitis

M. W. Shepherd, J. B. Wallis; LSU Health Sciences Center, New Orleans,

LA.

RATIONALE: Intranasal corticosteroids are the most effective therapy

for allergic rhinitis according to the Joint Task Force on Practice

Parameters in Allergy, Asthma, and Immunology. The federally mandated

electronic health record (EHR) is a useful tool to assess adherence to clin-

ical practice guidelines. We used analysis of the EHR to evaluate how often

a primary care clinic prescribes intranasal corticosteroids in patients with

allergic rhinitis compared to an allergy clinic as well as the prevalence of

nasal steroid use in adult versus pediatric patients.

METHODS: Using the Allscripts EHR Analytics program, we pulled 556

patients with a diagnosis of Allergic Rhinitis (ICD-9 codes 477.x) from the

LSU MedPeds clinic and LSU Allergy clinic who both use the Allscripts

Enterprise EHR for patient visits. We then identified patients who were pre-

scribed a nasal steroid. We placed these lists in Excel 2007 and used pivots

tables to analyze the data and create charts. Chi square tests were used to

evaluate statistical significance (alpha 5 0.05) in SASv9.13.

RESULTS: The Allergy versus MedPeds clinic difference in use of nasal

steroids was 62.2% versus 47.8% which was statistically significant

(p 5 0.06). The difference in prescription rates between the pediatric

and adult populations in the MedPeds clinic was not statistically significant

(p 5 0.14).

CONCLUSIONS: We found that within the primary care clinic, intranasal

corticosteroids are prescribed less often for allergic rhinitis than in an al-

lergy clinic. We hypothesize that dissemination of these findings to practic-

ing primary care physicians might help them to better follow established

guidelines of patient care for allergic rhinitis patients.

129 Electronic Immunotherapy Record System (EIRS) is Efficientand Safe Compared to a Paper-Based System (PBS) in aMulti-centered Single Specialty Private Allergy Practice

A. D. Adinoff1, N. P. Joshi2, J. Milewski3; 1U of Colorado Health Sciences

Center, Denver, CO, 2none, none, CO, 3University of Denver, Denver, CO.

RATIONALE: CAAC has 10 Denver metropolitan area offices, adminis-

tering approximately 88,000 IT annually. In 2009, CAAC moved to

Meditab’s EIRS, which allows computerized patient/procedure tracking.

A cost-benefit analysis (CBA) of EIRS compared with PBS was performed.

We also asked the questions whether this system was accepted by staff.

METHODS: Data were collected from January-April. EIRS was imple-

mented at 5 offices by April, and compared with the 5 offices that remained

on PBS during that same time. To perform a CBA, we determined the return

on investment (ROI) of the EIRS (hardware, software, maintenance, sup-

plies, training, labor) compared to the PBS. An employee opinion survey

(EOP) was conducted.

RESULTS: During the study period approximately 30,000 IT were given.

The average time for IT was 150 seconds (SD 6 21.8) for the EIRS and

180 (SD 6 5.6) for the PBS (p < 0.001). The total cost for implementation

of EIRS was calculated to be $130,000 for all 10 offices; the benefit from

saved labor and supplies was calculated to be $65,734 each year. EOP

showed 81% of staff preferred EIRS, felt it was more efficient than PBS,

and easy to use.

CONCLUSION: EIRS improves the documentation and speed of IT by

eliminating redundant steps of PBS. It is cost efficient: the ROI is less

than 3 years. There was measurable positive acceptance by staff, which

was able to learn and incorporate the system quickly. Because EIRS tracks

errors and generates reports electronically, it easily works towards reduc-

ing errors, thus improving patient safety.

130 Epipen Demographics and Use in a V.A. PopulationA. Amirzadeh, W. Klaustermeyer; VA Greater Los Angeles,

Los Angeles, CA.

RATIONALE: Epinephrine auto injector (Epi-pen) use and demographic

data have not been studied in a VA population. This study investigates uti-

lization and patient’s understanding of Epi-pen use in this population.

METHODS: We conducted a survey of 66 patients who were prescribed

Epi-pen and followed in the Allergy and Immunology Clinics at the

West Los Angeles Veterans Hospital from January to July 2009. Data an-

alyzed included patient demographics, medical indication for Epi-pen pre-

scription, and patient’s understanding of the need for Epi-pen. Additional

data was obtained retrospectively from the computerized medical records.

RESULTS: The mean age of our patients was 50 years. There were 44 men

(66.7%) and 22 women (33%). Twenty three (23) patients were prescribed

Epi-pen for food reactions. Ninety two percent (92%) of the patients knew

how to use their Epi-pen properly, however, only 58% carried their Epi-pen

with them consistently. Of the patients, 91% understood why the Epi-pen

was prescribed. Of the total patients prescribed Epi-pen, 79% refilled their

medication before the one year expiration date. Only 12% of the patients

studied had required the use of their Epi-pen.

CONCLUSIONS: Most patients knew how and when to administer their

Epi-pen. Yet only a slight majority stated that they carried it consistently.

Despite instruction in a specialty clinic, this data clearly indicates that fur-

ther patient education or other measures are needed to improve

compliance.

131 Cetirizine Switch to Over-the Counter: Patient Response andImpact on Treatment Compliance

E. Urdaneta1, C. L. Lin2, C. R. Pollack2, B. Zimmerman1, M. Wu3, S.

Furey4, E. K. Kuffner1; 1McNeil Consumer Healthcare, Fort Washington,

PA, 2Consultant, Fort Washington, PA, 3Johnson & Johnson Consumer

Products Worldwide, Morris Plains, MO, 4Johnson & Johnson Consumer

Products Worldwide, Morris Plains, NJ.

RATIONALE: The January 2008 switch of cetirizine from prescription to

over-the-counter (OTC) availability provides allergy sufferers with a cost-

effective and accessible alternative to prescription H1-receptor antagonists

with similar efficacy. To better understand how the switch of cetirizine to

OTC status affected allergy sufferers, patients were queried about their

treatment decisions.

METHODS: Data regarding prescription and OTC antihistamine use, pa-

tients� reasons for use of specific products, and their satisfaction with symp-

tom responses were collected from diaries that were completed by

approximately 800 households and over 5100 patient surveys during the

first year of OTC availability. Patients� personal decisions regarding allergy

management and OTC cetirizine use were summarized.

RESULTS: Following the switch of cetirizine from prescription to OTC

status, patients and healthcare professionals opted for OTC cetirizine rather

than prescription antihistamines as demonstrated by a 27.7% reduction in

the number of antihistamine prescriptions filled. Patient-reported reasons

for using OTC cetirizine included: strong efficacy profile, previous avail-

ability as prescription drug, brand loyalty, and acknowledgment of special-

ists� recommendations of cetirizine. Among branded OTC antihistamines,

on average, patients reported using cetirizine 116 days annually and lora-

tadine or diphenhydramine 78 days each annually. Patients reported a high

degree of satisfaction with symptom relief with OTC cetirizine (28%) com-

pared to OTC loratadine (18%), diphenhydramine (14%), or other antihis-

tamines (15%).

CONCLUSIONS: Since switching from prescription to OTC status, cetir-

izine is highly accepted and used by allergy sufferers. Likely the combina-

tion of patient-proven effectiveness, ease of accessibility, and allergists�recommendations influence patients to use OTC cetirizine for effective

management of their allergy symptoms.