Randomized Trial to Improve Laboratory Safety Monitoring of Ongoing Drug Therapy in Ambulatory Patients

  1. Dr. Marsha A. Raebel Pharm.D.1,2,*,
  2. Dr. Elizabeth A. Chester Pharm.D.1,2,
  3. Ms. Elizabeth E. Newsom B.A.1,
  4. Ms. Ella E. Lyons M.S.1,
  5. Dr. Julia A. Kelleher Pharm.D.4,
  6. Dr. Charron Long Pharm.D.4,
  7. Mr. Chad Miller B.S.4,
  8. Dr. David J. Magid M.D., M.P.H.2,3

Article first published online: 6 JAN 2012

DOI: 10.1592/phco.26.5.619

Issue

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy

Volume 26, Issue 5, pages 619–626, May 2006

Additional Information

How to Cite

Raebel, M. A., Chester, E. A., Newsom, E. E., Lyons, E. E., Kelleher, J. A., Long, C., Miller, C. and Magid, D. J. (2006), Randomized Trial to Improve Laboratory Safety Monitoring of Ongoing Drug Therapy in Ambulatory Patients. Pharmacotherapy, 26: 619–626. doi: 10.1592/phco.26.5.619

Author Information

  1. 1

    Kaiser Permanente Colorado Clinical Research Unit, Denver, Colorado

  2. 2

    Schools of Pharmacy

  3. 3

    Medicine University of Colorado at Denver and Health Sciences Center, Denver, Colorado

  4. 4

    Kaiser Permanente Colorado Pharmacy Department, Aurora, Colorado

*Kaiser Permanente Colorado Clinical Research Unit, P.O. Box 378066, Denver, CO 80237–8066; e-mail: Marsha.A.Raebel@kp.org.

Publication History

  1. Issue published online: 6 JAN 2012
  2. Article first published online: 6 JAN 2012

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Keywords:

  • laboratory monitoring;
  • drug therapy;
  • ambulatory care;
  • computerized alert

Study Objective. To determine whether an electronic tool effectively increases the percentage of patients receiving laboratory monitoring during ongoing drug therapy.

Design. Randomized trial.

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

Patients. A total of 9139 patients prescribed ongoing therapy with any of 14 drugs, resulting in 4871 patient-drug combinations in the intervention group and 4780 in the usual-care (control) group.

Intervention. 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.

Measurements and Main Results. In the intervention group, 64% of patient-drug 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, 1472 (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.

Conclusion. A computerized tool plus collaboration of health care professionals effectively increased the number of patients who received laboratory safety monitoring of drug therapy.

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