title: Adherence to amiodarone monitoring recommendations before and after implementation of a centralized pharmacy service: a cohort study.
abstract: The objective of this study was to determine whether patients enrolled in a centralized amiodarone monitoring service (AMS) were more adherent to amiodarone surveillance and whether the incidence of amiodarone-related toxicity differed for patients who were enrolled in the AMS. Amiodarone therapy was initiated in 917 patients in an integrated health care delivery system between October 1998 and December 2006. Electronic records were queried to establish the proportion of patients completing recommended amiodarone monitoring during the first year of therapy; specifically, thyroid stimulating hormone (TSH), alanine aminotransferase (ALT), electrocardiogram (ECG), and chest radiograph (CXR). Patients were assigned to the AMS or control cohort based on when amiodarone was initiated. Patients assigned to the AMS cohort were more likely to receive ALT monitoring at baseline, 6 months, and 1 year (68% vs 44%, P < .001; 86% vs 76%, P = .002; 84% vs 69%, P < .001; respectively) and ECG monitoring at baseline and 1 year (76% vs 58%; 96% vs 75%, P < .001, respectively). There was no difference in TSH monitoring at baseline, 6 months, and 1 year (55% vs 49%, P = not significant [NS]; 74% vs 70%, P = NS; 68% vs 64%, P = NS; respectively).
authors.affiliation: Kaiser Permanente Colorado, Aurora, CO 80205, USA. samuel.g.johnson@kp.org
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Johnson
authors.forename: Kara
authors.initials: K
authors.lastname: Canty
authors.forename: Sarah
authors.initials: S
authors.lastname: Billups
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schimmer
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000553:Ambulatory Care; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002309:Cardiology; D015331:Cohort Studies; D003133:Commission on Professional and Hospital Activities; D016903:Drug Monitoring; D004562:Electrocardiography / Q000187:drug effects; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D010593:Pharmaceutical Services; D013972:Thyrotropin / Q000097:blood; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D013972:Thyrotropin; D000410:Alanine Transaminase; D000638:Amiodarone