Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees.
OBJECTIVE
To identify correlates of laboratory monitoring errors in elderly health maintenance organization (HMO) members at the initiation of therapy with cardiovascular medications.


METHODS
Cross-sectional study in 10 HMOs.


METHODS
United States.


METHODS
From a 2 million-member sample, individuals aged 65 and older who received one of seven cardiovascular medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), amiodarone, digoxin, diuretics, potassium supplements, and statins) and did not have recommended baseline monitoring performed during the 180 days before or 14 days after the index dispensing.


METHODS
The proportion of members receiving each drug for whom recommended laboratory monitoring was not performed. Laboratory monitoring error rates stratified by sex, age group, chronic disease score, and HMO site were examined, and logistic regression was used to identify predictors of laboratory monitoring errors.


RESULTS
Error rates varied by medication class, ranging from 23% of patients receiving potassium supplementation without serum potassium and serum creatinine monitoring to 58% of patients receiving amiodarone who did not have recommended monitoring for thyroid and liver function. Highest error rates occurred in the youngest elderly for ACE inhibitors, ARBs, digoxin, diuretics, and potassium supplements, although in patients receiving amiodarone and statins, errors were most frequent in the oldest elderly. Errors occurred more frequently in patients with less comorbidity.


CONCLUSIONS
Laboratory monitoring errors occurred frequently in elderly HMO members at the initiation of therapy with cardiovascular medications. Further study must examine the association between these errors and adverse outcomes.
Simon
Steven R
SR
HMO Research Network Center for Education and Research in Therapeutics and Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA. steven_simon@hms.harvard.edu
Andrade
Susan E
SE
Ellis
Jennifer L
JL
Nelson
Winnie W
WW
Gurwitz
Jerry H
JH
Lafata
Jennifer Elston
JE
Davis
Robert L
RL
Feldstein
Adrianne
A
Raebel
Marsha A
MA
D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D019411:Clinical Laboratory Techniques; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents