title: The pharmacists' role in improving guideline compliance for thyroid function testing in patients with heart failure.
abstract: This single-center retrospective pilot program's objective was to utilize outpatient pharmacists to improve laboratory test adherence in chronic heart failure (CHF) patients overdue for thyroid function testing, thereby demonstrating the value of the outpatient pharmacist and justifying possible clinical role expansion. Thyroid disorders may contribute to CHF development, progression, and exacerbation. Testing is the standard of care in CHF patients per American Heart Association's 2009 Guidelines. Delinquency was defined as labs not conducted within 1 year in patients with euthyroid history, within 6 months in patients with thyroid dysfunction, abnormal labs at any time without follow-up, or lab absence after thyroid medication initiation, adjustment, or discontinuation. Targeted 80 nonpregnant adult CHF patients with delinquent thyroid function tests were counseled to get thyroid labs at point of sale, via telephone, e-mail, or letter. In collaboration with physicians, pharmacists ordered thyroid-stimulating hormone (TSH) and free T4 (FT4) labs. For patients with abnormal laboratory results, pharmacists coordinated drug therapy and follow-up labs. Data were collected from November 1, 2009 to March 30, 2010. Seventy-two patients (90%) previously delinquent for thyroid function testing received relevant thyroid labs. Ten patients (12.5%) with abnormal thyroid function tests not on prior drug therapy received treatment.
authors.affiliation: Department of Pharmacy, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA 95823, USA. melanie.e.ziman@kp.org
authors.forename: Melanie E
authors.initials: ME
authors.lastname: Ziman
authors.forename: Hien T
authors.initials: HT
authors.lastname: Bui
authors.forename: Craig S
authors.initials: CS
authors.lastname: Smith
authors.forename: Lori A
authors.initials: LA
authors.lastname: Tsukiji
authors.forename: Veda M
authors.initials: VM
authors.lastname: Asmatey
authors.forename: Steven B
authors.initials: SB
authors.lastname: Chu
authors.forename: John S
authors.initials: JS
authors.lastname: Miano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010595:Pharmacists; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D024382:Professional Role; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000150:complications* / Q000188:drug therapy; D013960:Thyroid Function Tests / Q000379:methods* / Q000592:standards; D013972:Thyrotropin / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D013972:Thyrotropin