Adherence to Amiodarone Monitoring Recommendations Before and After Implementation of a Centralized Pharmacy Service

Abstract

The objective of this study was to determine whether patients enrolled in a centralized amiodarone monitoring service (AMS) were more adherent to amiodarone surveillance and whether the incidence of amiodarone-related toxicity differed for patients who were enrolled in the AMS. Amiodarone therapy was initiated in 917 patients in an integrated health care delivery system between October 1998 and December 2006. Electronic records were queried to establish the proportion of patients completing recommended amiodarone monitoring during the first year of therapy; specifically, thyroid stimulating hormone (TSH), alanine aminotransferase (ALT), electrocardiogram (ECG), and chest radiograph (CXR). Patients were assigned to the AMS or control cohort based on when amiodarone was initiated. Patients assigned to the AMS cohort were more likely to receive ALT monitoring at baseline, 6 months, and 1 year (68% vs 44%, P < .001; 86% vs 76%, P = .002; 84% vs 69%, P < .001; respectively) and ECG monitoring at baseline and 1 year (76% vs 58%; 96% vs 75%, P < .001, respectively). There was no difference in TSH monitoring at baseline, 6 months, and 1 year (55% vs 49%, P = not significant [NS]; 74% vs 70%, P = NS; 68% vs 64%, P = NS; respectively).

Adherence to guidelines in monitoring amiodarone‐induced thyroid dysfunction

“…To improve adherence to guidelines in drug monitoring, pharmacist‐involved and/or computerized programmes have been established . However, not all pharmacist‐involved programmes successfully increased the rate of thyroid monitoring under amiodarone usage .…”

Evaluation of a Pharmacist-Managed Amiodarone Monitoring Program

“…Thyroid-related events (also defined using ICD-9-CM codes for thyroid disease and confirmed through manual chart review) occurred in 3.9% of the AMS group and 6% of patients prior to AMS implementation. 14 We found very small numbers of patients with abnormal TSH and T4 lab results who were hospitalized or had an ER visit. 23 These services were mostly hospital based, which may account for the higher ROI compared with the present study.…”

Comparison of Amiodarone Compliance Monitoring: Usual Care, Electronic Prescribing Template and Pharmacist-Managed Clinic

“…and Sanoski et al [9,11]. Both studies showed improved adherence to recommended monitoring through implementation of an amiodarone monitoring service and a multidisciplinary clinic compared to usual care, respectively.…”

“…A recent review suggested about 50% of the patients starting amiodarone received minimum baseline evaluation and less than 25% received the recommended ongoing surveillance [8]. Several studies have also been published describing the need for amiodarone drug monitoring [9,10]; however, no universally accepted and feasible approach is available.…”