Randomized trial to improve laboratory safety monitoring of ongoing drug therapy in ambulatory patients.
OBJECTIVE
To determine whether an electronic tool effectively increases the percentage of patients receiving laboratory monitoring during ongoing drug therapy.


METHODS
Randomized trial.


METHODS
Outpatient medical offices of a group model health maintenance organization.


METHODS
A total of 9,139 patients prescribed ongoing therapy with any of 14 drugs, resulting in 4,871 patient-drug combinations in the intervention group and 4,780 in the usual-care (control) group.


METHODS
Physicians and pharmacists jointly developed monitoring guidelines based on published recommendations. Pharmacists were electronically alerted to missing laboratory results and then ordered tests, reminded patients to undergo tests, and reviewed and managed abnormal results.


RESULTS
In the intervention group, 64% of patientdrug combinations were monitored, whereas in the usual-care group 58% were monitored (p < 0.001). Differences in monitoring were observed in the intervention versus usual-care groups for amiodarone (71% vs 55%, p<0.01), theophylline (54% vs 28%, p<0.001), carbamazepine (49% vs 32%, p<0.001), lithium (42% vs 28%, p<0.01), phenytoin (44% vs 33%, p<0.001), and metformin (72% vs 67%, p<0.001). Of 1981 laboratory tests ordered, 1,472 (74%) were completed. The tests revealed 181 serum drug concentrations outside the therapeutic range and 126 abnormal serum creatinine, alanine aminotransferase, aspartate aminotransferase, and thyroid-stimulating hormone levels, and complete blood counts.


CONCLUSIONS
A computerized tool plus collaboration of health care professionals effectively increased the number of patients who received laboratory safety monitoring of drug therapy.
Raebel
Marsha A
MA
Kaiser Permannente Colorado Clinical Research Unit, Denver, 80237-8066, USA. Raebel@kp.org
Chester
Elizabeth A
EA
Newsom
Elizabeth E
EE
Lyons
Ella E
EE
Kelleher
Julia A
JA
Long
Charron
C
Miller
Chad
C
Magid
David J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado; D016903:Drug Monitoring / Q000295:instrumentation*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010595:Pharmacists; D010820:Physicians; D017751:Safety Management