Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees

Steven R. Simon, Susan E. Andrade, Jennifer L. Ellis, Winnie W. Nelson, Jerry H. Gurwitz, Jennifer Elston Lafata, Robert Davis, Adrianne Feldstein, Marsha A. Raebel

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVES: To identify correlates of laboratory monitoring errors in elderly health maintenance organization (HMO) members at the initiation of therapy with cardiovascular medications. DESIGN: Cross-sectional study in 10 HMOs. SETTING: United States. PARTICIPANTS: From a 2 million-member sample, individuals aged 65 and older who received one of seven cardiovascular medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), amiodarone, digoxin, diuretics, potassium supplements, and statins) and did not have recommended baseline monitoring performed during the 180 days before or 14 days after the index dispensing. MEASUREMENTS: The proportion of members receiving each drug for whom recommended laboratory monitoring was not performed. Laboratory monitoring error rates stratified by sex, age group, chronic disease score, and HMO site were examined, and logistic regression was used to identify predictors of laboratory monitoring errors. RESULTS: Error rates varied by medication class, ranging from 23% of patients receiving potassium supplementation without serum potassium and serum creatinine monitoring to 58% of patients receiving amiodarone who did not have recommended monitoring for thyroid and liver function. Highest error rates occurred in the youngest elderly for ACE inhibitors, ARBs, digoxin, diuretics, and potassium supplements, although in patients receiving amiodarone and statins, errors were most frequent in the oldest elderly. Errors occurred more frequently in patients with less comorbidity. CONCLUSION: Laboratory monitoring errors occurred frequently in elderly HMO members at the initiation of therapy with cardiovascular medications. Further study must examine the association between these errors and adverse outcomes.

Original languageEnglish (US)
Pages (from-to)2165-2169
Number of pages5
JournalJournal of the American Geriatrics Society
Volume53
Issue number12
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

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Health Maintenance Organizations
Amiodarone
Potassium
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Digoxin
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Serum
Comorbidity
Creatinine
Thyroid Gland
Chronic Disease
Age Groups
Cross-Sectional Studies
Logistic Models
Liver
Therapeutics
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology

Cite this

Simon, S. R., Andrade, S. E., Ellis, J. L., Nelson, W. W., Gurwitz, J. H., Lafata, J. E., ... Raebel, M. A. (2005). Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees. Journal of the American Geriatrics Society, 53(12), 2165-2169. https://doi.org/10.1111/j.1532-5415.2005.00498.x

Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees. / Simon, Steven R.; Andrade, Susan E.; Ellis, Jennifer L.; Nelson, Winnie W.; Gurwitz, Jerry H.; Lafata, Jennifer Elston; Davis, Robert; Feldstein, Adrianne; Raebel, Marsha A.

In: Journal of the American Geriatrics Society, Vol. 53, No. 12, 01.12.2005, p. 2165-2169.

Research output: Contribution to journalArticle

Simon, SR, Andrade, SE, Ellis, JL, Nelson, WW, Gurwitz, JH, Lafata, JE, Davis, R, Feldstein, A & Raebel, MA 2005, 'Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees', Journal of the American Geriatrics Society, vol. 53, no. 12, pp. 2165-2169. https://doi.org/10.1111/j.1532-5415.2005.00498.x
Simon, Steven R. ; Andrade, Susan E. ; Ellis, Jennifer L. ; Nelson, Winnie W. ; Gurwitz, Jerry H. ; Lafata, Jennifer Elston ; Davis, Robert ; Feldstein, Adrianne ; Raebel, Marsha A. / Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees. In: Journal of the American Geriatrics Society. 2005 ; Vol. 53, No. 12. pp. 2165-2169.
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AU - Andrade, Susan E.

AU - Ellis, Jennifer L.

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AU - Gurwitz, Jerry H.

AU - Lafata, Jennifer Elston

AU - Davis, Robert

AU - Feldstein, Adrianne

AU - Raebel, Marsha A.

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N2 - OBJECTIVES: To identify correlates of laboratory monitoring errors in elderly health maintenance organization (HMO) members at the initiation of therapy with cardiovascular medications. DESIGN: Cross-sectional study in 10 HMOs. SETTING: United States. PARTICIPANTS: From a 2 million-member sample, individuals aged 65 and older who received one of seven cardiovascular medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), amiodarone, digoxin, diuretics, potassium supplements, and statins) and did not have recommended baseline monitoring performed during the 180 days before or 14 days after the index dispensing. MEASUREMENTS: The proportion of members receiving each drug for whom recommended laboratory monitoring was not performed. Laboratory monitoring error rates stratified by sex, age group, chronic disease score, and HMO site were examined, and logistic regression was used to identify predictors of laboratory monitoring errors. RESULTS: Error rates varied by medication class, ranging from 23% of patients receiving potassium supplementation without serum potassium and serum creatinine monitoring to 58% of patients receiving amiodarone who did not have recommended monitoring for thyroid and liver function. Highest error rates occurred in the youngest elderly for ACE inhibitors, ARBs, digoxin, diuretics, and potassium supplements, although in patients receiving amiodarone and statins, errors were most frequent in the oldest elderly. Errors occurred more frequently in patients with less comorbidity. CONCLUSION: Laboratory monitoring errors occurred frequently in elderly HMO members at the initiation of therapy with cardiovascular medications. Further study must examine the association between these errors and adverse outcomes.

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