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How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals.
Intern Med J. 2007 May;37(5):308-14.
Lin MW, Kirkpatrick PE, Riminton DS.
Department of Immunology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
BACKGROUND:
The clinical demand for i.v. immunoglobulin (IVIg) continues to
increase in Australia for reasons that are not clear. IVIg is
distributed for approved indications according to Australian Health
Ministers' Advisory Council 2000 guidelines that are currently under
review. IVIg may also be purchased by hospitals for uses not covered by
these indications on an individual patient use basis. These audits were
developed to examine current hospital practice in IVIg use.
METHODS:
Six-month prospective audits of all IVIg use were conducted at two
teaching hospitals in Sydney (Concord and Royal Prince Alfred
Hospitals). Medical files and dispensing records were examined and
compared with current guidelines. RESULTS: One hundred and sixty-five
recipients received 24,251 g of IVIg (mean total use 147 g/patient) for
36 distinct diagnoses, with 5.5% mortality. Drug committees supplied
1580 g of IVIg (6.5% of total product issued) to 12 recipients (7.3% of
total recipients). The clinical specialties of immunology, haematology
and neurology accounted for 92.9% of IVIg use, with 51.8% of overall
use for replacement indications. Forty-two patients (25.5%) received
IVIg for non-category 1 indications (4718 g, 19.5% of total product).
Patients receiving IVIg for category 1 disorders had a 94.4% compliance
with the guideline prerequisites where data were sufficient for
assessment. DISCUSSION: Our findings show a greater than expected
proportion of non-category 1 IVIg use and substantial contributions
from drug committees. Careful case selection within category 1
indications is evident in the high level of compliance with qualifying
criteria. Current distribution procedures do not enable capture of
outcome data to inform guideline revisions. CONCLUSION: These audits
emphasize the requirement for updated National Clinical Practice
Guidelines, improved approval procedures, consensus statements in the
specialties of immunology, haematology and neurology and clarification
of the role of drug committees.
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