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.
RCT Entities:
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.
Authors: Lauren B Cooper; Bradley G Hammill; Eric D Peterson; Bertram Pitt; Matthew L Maciejewski; Lesley H Curtis; Adrian F Hernandez Journal: Circ Cardiovasc Qual Outcomes Date: 2017-01
Authors: Erik Nilsson; Pietro De Deco; Marco Trevisan; Rino Bellocco; Bengt Lindholm; Lars H Lund; Josef Coresh; Juan J Carrero Journal: Eur Heart J Qual Care Clin Outcomes Date: 2018-10-01
Authors: K Ann McKibbon; Cynthia Lokker; Steven M Handler; Lisa R Dolovich; Anne M Holbrook; Daria O'Reilly; Robyn Tamblyn; Brian J Hemens; Runki Basu; Sue Troyan; Pavel S Roshanov Journal: J Am Med Inform Assoc Date: 2011-08-18 Impact factor: 4.497
Authors: Helen G Lo; Michael E Matheny; Diane L Seger; David W Bates; Tejal K Gandhi Journal: J Am Med Inform Assoc Date: 2008-10-24 Impact factor: 4.497
Authors: Shira H Fischer; Terry S Field; Shawn J Gagne; Kathleen M Mazor; Peggy Preusse; George Reed; Daniel Peterson; Jerry H Gurwitz; Jennifer Tjia Journal: J Gen Intern Med Date: 2012-11-15 Impact factor: 5.128
Authors: Shira H Fischer; Jennifer Tjia; George Reed; Daniel Peterson; Jerry H Gurwitz; Terry S Field Journal: J Gen Intern Med Date: 2014-06-26 Impact factor: 5.128
Authors: Marsha A Raebel; Nikki M Carroll; Julia A Kelleher; Elizabeth A Chester; Sally Berga; David J Magid Journal: J Am Med Inform Assoc Date: 2007-04-25 Impact factor: 4.497
Authors: Gianfranco Damiani; Luigi Pinnarelli; Simona C Colosimo; Roberta Almiento; Lorella Sicuro; Rocco Galasso; Lorenzo Sommella; Walter Ricciardi Journal: BMC Health Serv Res Date: 2010-01-04 Impact factor: 2.655