Laboratory monitoring of high-risk medications varies greatly
Research Activities, May 2011, No. 369
Even for drugs for which there is general agreement on the need for laboratory monitoring, the prevalence of such monitoring varies greatly depending on the drug and whether it is a new or continuing prescription, according to a new study. Drugs that are prescribed infrequently are most likely to be poorly monitored, the researchers found. Overall, for a group of 30 ambulatory care clinics in New England, the rates of drug monitoring test completion ranged from 0 to 88 percent for new drug prescriptions and from 22 to 97 percent for ongoing prescriptions. For the majority of patients (more than 75 percent) given new prescriptions, less than 20 percent of the recommended monitoring tests were done. In contrast, for a comparable majority of patients with ongoing prescriptions for chronic conditions, close to 40 percent of the recommended monitoring tests were done.
The researchers conducted their study in a large multispecialty practice in which 250 clinicians at 30 ambulatory clinic sites provided outpatient care to about 180,000 individuals. The lists of high-risk drugs and laboratory monitoring guidelines were developed by a panel of experts and local health plan leaders.
After identification of 35 high-risk drugs and 61 recommended monitoring tests (some drugs required more than one monitoring test), 2 research pharmacists determined the appropriate frequency for laboratory monitoring by review of the existing scientific literature and available guidelines. Overall, 15 drugs required more than 1 laboratory test for monitoring and the remaining 20 required only 1 test. The study was funded in part by the Agency for Healthcare Research and Quality (HS17203, HS17817, and HS17906).
More details are in "Development and pilot testing of guidelines to monitor high-risk medications in the ambulatory setting," by Jennifer Tjia, M.D., M.S.C.E., Terry S. Field, D.Sc., Lawrence D. Garber, M.D., and others in the American Journal of Managed Care 16(7); pp. 489-496, 2010.