Academic detailing to improve laboratory testing among outpatient medication users.
OBJECTIVE
To determine whether group academic detailing with performance feedback increases recommended laboratory monitoring among outpatients dispensed medications.


METHODS
Thirty-eight primary care practices in 3 states were randomized to group academic detailing with physician-level performance feedback (intervention) or a control group. Adjusted differences in creatinine and potassium testing between intervention and control group patients with a new or continuing dispensing for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), diuretics, or digoxin were evaluated using generalized estimating equation approaches.


RESULTS
Monitoring among patients with an initial ACE/ARB and diuretic dispensing significantly improved with the intervention [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.08-1.38; and OR = 1.25, 95% CI: 1.08-1.44, respectively). The intervention also significantly improved monitoring among patients with a continuing dispensing for an ACE/ARB (OR = 1.39, 95% CI: 1.11-1.74) or a diuretic (OR = 1.28, 95% CI: 1.02-1.60). Adjusted differences in testing rates between study arms were modest (ranging from 2.5% to 4.9%). No significant differences in monitoring by study arm were detected among patients dispensed digoxin.


CONCLUSIONS
The impact of a group academic detailing program with feedback on recommended laboratory monitoring among medication users was modest. Yet, given the numbers of outpatients dispensed medications for which laboratory monitoring is recommended, group academic detailing may offer 1 method by which outpatient medication safety can be significantly improved.
Lafata
Jennifer Elston
JE
Department of Internal Medicine, Center for Health Services Research, Henry Ford Health System, Detroit, Michigan, USA. jlafata1@hfhs.org
Gunter
Margaret J
MJ
Hsu
John
J
Kaatz
Scott
S
Krajenta
Richard
R
Platt
Richard
R
Schultz
Lonni
L
Selby
Joseph V
JV
Simon
Steven R
SR
Simpkins
Jan
J
Soumerai
Stephen B
SB
Uratsu
Connie
C
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000097:blood; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors