title: Identification of patients for pharmacologic review by computer analysis of clinical laboratory drug concentration data.
abstract: Clinical pharmacokinetics evaluation and consultation can improve drug therapy and decrease the incidence of adverse reactions in selected patients. However, identification of patients appropriate for review is difficult. The authors developed a microcomputer-based expert system that scans clinical laboratory drug concentration data to identify patients for follow-up. Rules were developed from a review of data for digoxin, phenytoin, and theophylline. These were implemented in software that provides for simple rule creation and modification, on-screen graphic review of data, and printing of chart reports. This program is readily adapted for use with most laboratory information systems. In a retrospective study of 868 patients monitored for digoxin, phenytoin, and theophylline, 29% were flagged as having drug level profiles of possible concern. The majority (62%) of these patients had multiple specimens flagged, suggesting persistent problems. These data suggest that patients can be identified for follow-up by scanning serial drug concentrations, allowing consultative resources to be focused on patients most likely to benefit from them.
authors.affiliation: Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Harrison
authors.forename: P M
authors.initials: PM
authors.lastname: Rainey
mesh_terms: D002984:Clinical Laboratory Information Systems; D003201:Computers; D016903:Drug Monitoring / Q000379:methods*; D005103:Expert Systems; D006801:Humans; D007297:Inpatients; D009994:Osmolar Concentration; D010045:Outpatients; D010560:Personnel Selection / Q000379:methods*; D010599:Pharmacokinetics