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Patient Safety and Quality

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Medication monitoring advice and feedback to physicians modestly improves outpatient medication safety

Patients taking angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), diuretics, and digoxin—medications commonly prescribed in primary care—must be monitored with regular laboratory tests for creatinine and/or potassium levels to prevent potential kidney, heart, and other damage. A practice called academic detailing modestly improves laboratory monitoring of these medications, according to a new study. Given the many outpatients dispensed medications for which laboratory monitoring is recommended, group academic detailing may be one way to significantly improve outpatient medication safety, suggests the study authors.

The academic detailing was facilitated by local physician peer leaders and clinical pharmacists. It included one-on-one consulting, educational sessions, written information on recommended prescribing and monitoring practices, and individual feedback to physicians. The researchers randomized 38 primary care practices in three States to group academic detailing or a control group.

In the academic detailing clinics, laboratory monitoring of patients newly dispensed an ACEI/ARB or diuretic, and of patients continually dispensed an ACEI/ARB or diuretic significantly improved. However, after adjusting for other factors, laboratory testing rates between the intervention and control clinics was modest (ranging from 2.5 to 4.9 percent). There were no differences between the two groups in laboratory monitoring of patients dispensed digoxin. The study was supported by the Agency for Healthcare Research and Quality (HS11843).

See "Academic detailing to improve laboratory testing among outpatient medication users," by Jennifer Elston Lafata, Ph.D., Margaret J. Gunter, Ph.D., John Hsu, M.D., and others, in the October 2007 Medical Care 45(10), pp. 966-972.

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