Serum drug level utilization review in a family medicine residency program.

A total of 161 tests, comprising six of the most commonly ordered serum drug levels (SDLs) in a family medicine residency program, were audited retrospectively by a review panel. Audit criteria assessed the appropriateness of three factors associated with this laboratory test ordering procedure: (1) indication for the level, (2) procedure and documentation, and (3) physician utilization of the results. There were no statistically significant differences (P less than .05) when comparing the percentage of appropriate indications and uses with the individual drug levels ordered or with the number of years in practice. However, this audit indicated that a large number of therapeutic decisions were based upon information obtained from improperly ordered SDLs. Also, lack of proper documentation and charting of SDLs appeared to hamper optimal continuity of care in a clinic where patients were seen by several physicians. It is suggested that educational and administrative strategies may be effective in promoting better ordering and use of laboratory tests by family physicians in the future.