Laboratory monitoring of drugs at initiation of therapy in ambulatory care

Marsha A. Raebel, Ella E. Lyons, Susan E. Andrade, K. Arnold Chan, Elizabeth A. Chester, Robert Davis, Jennifer L. Ellis, Adrianne Feldstein, Margaret J. Gunter, Jennifer Elston Lafata, Charron L. Long, David J. Magid, Joseph V. Selby, Steven R. Simon, Richard Platt

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Product labeling and published guidelines reflect the importance of monitoring laboratory parameters for drugs with a risk of organ system toxicity or electrolyte imbalance. Limited information exists about adherence to laboratory monitoring recommendations. The objective of this study was to describe laboratory monitoring among ambulatory patients dispensed medications for which laboratory testing is recommended at therapy initiation. DESIGN AND SUBJECTS: We conducted a retrospective cross-sectional analysis of patients in 10 geographically distributed health maintenance organizations who were newly prescribed medications with recommended laboratory test monitoring. The main outcome measure was the proportion of initial drug dispensing without recommended baseline laboratory monitoring for 35 newly initiated drugs or drug classes. RESULTS: One hundred seven thousand, seven hundred sixty-three of 279,354 (39%) initial drug dispensings occurred without recommended laboratory monitoring. Patients without monitoring were younger than patients who had monitoring (median 57 vs 61 years, P< .001). Thirty-two percent of dispensings where a serum creatinine was indicated did not have it evaluated (range across drugs, 12% to 61%); 39% did not have liver function testing (range 10% to 75%); 32% did not have hematologic monitoring (range 9% to 51%); and 34% did not have electrolyte monitoring (range 20% to 62%) (P<.001). CONCLUSIONS: Substantial opportunity exists to improve laboratory monitoring of drugs for which such monitoring is recommended. This study emphasizes the need for research to identify the clinical implications of not conducting recommended laboratory monitoring, existing barriers to monitoring, and methods to improve practice.

Original languageEnglish (US)
Pages (from-to)1120-1126
Number of pages7
JournalJournal of General Internal Medicine
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2005

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Drug Monitoring
Ambulatory Care
Pharmaceutical Preparations
Therapeutics
Electrolytes
Product Labeling
Ambulatory Monitoring
Health Maintenance Organizations
Physiologic Monitoring
Creatinine
Cross-Sectional Studies
Outcome Assessment (Health Care)
Guidelines
Liver

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Raebel, M. A., Lyons, E. E., Andrade, S. E., Chan, K. A., Chester, E. A., Davis, R., ... Platt, R. (2005). Laboratory monitoring of drugs at initiation of therapy in ambulatory care. Journal of General Internal Medicine, 20(12), 1120-1126. https://doi.org/10.1111/j.1525-1497.2005.0257.x

Laboratory monitoring of drugs at initiation of therapy in ambulatory care. / Raebel, Marsha A.; Lyons, Ella E.; Andrade, Susan E.; Chan, K. Arnold; Chester, Elizabeth A.; Davis, Robert; Ellis, Jennifer L.; Feldstein, Adrianne; Gunter, Margaret J.; Lafata, Jennifer Elston; Long, Charron L.; Magid, David J.; Selby, Joseph V.; Simon, Steven R.; Platt, Richard.

In: Journal of General Internal Medicine, Vol. 20, No. 12, 01.12.2005, p. 1120-1126.

Research output: Contribution to journalArticle

Raebel, MA, Lyons, EE, Andrade, SE, Chan, KA, Chester, EA, Davis, R, Ellis, JL, Feldstein, A, Gunter, MJ, Lafata, JE, Long, CL, Magid, DJ, Selby, JV, Simon, SR & Platt, R 2005, 'Laboratory monitoring of drugs at initiation of therapy in ambulatory care', Journal of General Internal Medicine, vol. 20, no. 12, pp. 1120-1126. https://doi.org/10.1111/j.1525-1497.2005.0257.x
Raebel, Marsha A. ; Lyons, Ella E. ; Andrade, Susan E. ; Chan, K. Arnold ; Chester, Elizabeth A. ; Davis, Robert ; Ellis, Jennifer L. ; Feldstein, Adrianne ; Gunter, Margaret J. ; Lafata, Jennifer Elston ; Long, Charron L. ; Magid, David J. ; Selby, Joseph V. ; Simon, Steven R. ; Platt, Richard. / Laboratory monitoring of drugs at initiation of therapy in ambulatory care. In: Journal of General Internal Medicine. 2005 ; Vol. 20, No. 12. pp. 1120-1126.
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abstract = "BACKGROUND AND OBJECTIVES: Product labeling and published guidelines reflect the importance of monitoring laboratory parameters for drugs with a risk of organ system toxicity or electrolyte imbalance. Limited information exists about adherence to laboratory monitoring recommendations. The objective of this study was to describe laboratory monitoring among ambulatory patients dispensed medications for which laboratory testing is recommended at therapy initiation. DESIGN AND SUBJECTS: We conducted a retrospective cross-sectional analysis of patients in 10 geographically distributed health maintenance organizations who were newly prescribed medications with recommended laboratory test monitoring. The main outcome measure was the proportion of initial drug dispensing without recommended baseline laboratory monitoring for 35 newly initiated drugs or drug classes. RESULTS: One hundred seven thousand, seven hundred sixty-three of 279,354 (39{\%}) initial drug dispensings occurred without recommended laboratory monitoring. Patients without monitoring were younger than patients who had monitoring (median 57 vs 61 years, P< .001). Thirty-two percent of dispensings where a serum creatinine was indicated did not have it evaluated (range across drugs, 12{\%} to 61{\%}); 39{\%} did not have liver function testing (range 10{\%} to 75{\%}); 32{\%} did not have hematologic monitoring (range 9{\%} to 51{\%}); and 34{\%} did not have electrolyte monitoring (range 20{\%} to 62{\%}) (P<.001). CONCLUSIONS: Substantial opportunity exists to improve laboratory monitoring of drugs for which such monitoring is recommended. This study emphasizes the need for research to identify the clinical implications of not conducting recommended laboratory monitoring, existing barriers to monitoring, and methods to improve practice.",
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AU - Andrade, Susan E.

AU - Chan, K. Arnold

AU - Chester, Elizabeth A.

AU - Davis, Robert

AU - Ellis, Jennifer L.

AU - Feldstein, Adrianne

AU - Gunter, Margaret J.

AU - Lafata, Jennifer Elston

AU - Long, Charron L.

AU - Magid, David J.

AU - Selby, Joseph V.

AU - Simon, Steven R.

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