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Improving Laboratory Monitoring at Initiation of Drug Therapy in Ambulatory Care
A Randomized Trial
Marsha A. Raebel, PharmD;
Ella E. Lyons, MS;
Elizabeth A. Chester, PharmD;
Michael A. Bodily, MBA;
Julia A. Kelleher, PharmD;
Charron L. Long, PharmD;
Chad Miller, BS;
David J. Magid, MD, MPH
Arch Intern Med. 2005;165:2395-2401.
Background The importance of laboratory monitoring for drugs is reflected in product labeling and published guidelines, but monitoring recommendations are followed inconsistently. Opportunity exists to improve monitoring, with the potential to decrease therapy complications.
Methods The objective of this randomized trial was to determine whether computerized alerts were effective at increasing the percentage of ambulatory patients with laboratory monitoring at initiation of drug therapy. Physicians and pharmacists teamed up to develop organization-specific guidelines for monitoring selected drugs. In collaboration with physicians, pharmacists were alerted to missing laboratory test results, ordered missing tests, reminded patients to obtain tests, assessed test completion, reviewed test results, and managed abnormal results. Eligible individuals included patients with therapy initiated for any of 15 drugs among 400 000 health plan members.
Results In the intervention group, 79.1% (n = 4076; 95% confidence interval [CI], 78.0%-80.2%) of dispensings were monitored compared with 70.2% (n = 3522; 95% CI, 68.9%-71.5%) in the usual-care group (P<.001). For example, 78.6% of amiodarone (95% CI, 73.1%-83.5%) dispensing was monitored in the intervention group vs 51.4% (95% CI, 44.4%-58.4%) in the group receiving usual care (P<.001).
Conclusions This study demonstrates the effectiveness of a computerized tool plus collaboration among health care professionals at increasing the percentage of patients receiving laboratory monitoring at initiation of therapy. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can result in improved patient monitoring.
Author Affiliations: Clinical Research Unit (Drs Raebel, Long, and Magid, Ms Lyons, and Mr Bodily) and Pharmacy Department (Drs Chester and Kelleher and Mr Miller), Kaiser Permanente of Colorado, Denver; and Schools of Pharmacy (Drs Raebel, Chester, and Kelleher) and Medicine (Dr Magid), University of Colorado and Health Sciences Center, Denver. Dr Long is now with Medical Affairs, Allergan Inc, Lakeville, Mass.
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