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Computerized alerts and professional collaboration improve laboratory monitoring of outpatients starting new medications

Some medications carry a risk of organ toxicity or electrolyte imbalance or require dosage adjustment in the presence of organ dysfunction. Thus, laboratory tests are needed to establish organ baseline functioning before a doctor can prescribe certain new drugs for patients, and tests are needed to periodically monitor functioning. Doctors vary in how consistently they follow laboratory monitoring guidelines when beginning drug therapy for outpatients. A study supported in part by the Agency for Healthcare Research and Quality (HS14249) shows that computerized alerts plus collaboration between pharmacists and doctors increases the percentage of patients receiving necessary laboratory monitoring when they begin new medications.

In the study, physicians and pharmacists at a large HMO teamed up to develop organization-specific guidelines for monitoring health plan members who began therapy with any of 15 selected drugs. They linked laboratory and drug-dispensing information to identify gaps in lab monitoring. 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.

Overall, nearly 80 percent of dispensed medications were monitored in the group that received computerized alerts and collaboration compared with 70 percent in the usual-care group. For example, the collaborative group used laboratory tests to monitor for liver and thyroid function in 79 percent of dispensings of the antiarrhythmic drug amiodarone, which can impair liver and thyroid function, compared to 51 percent in the usual-care group. Thirteen percent of 86 patients started on a regimen of amiodarone had abnormal results for liver or thyroid tests.

More details are in "Improving laboratory monitoring at initiation of drug therapy in ambulatory care," by Marsha A. Raebel, Pharm.D., Ella E. Lyons, M.S., Elizabeth A. Chester, Pharm.D., and others, in the November 14, 2005, Archives of Internal Medicine 165, pp. 2395-2401.

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