Randomized Trial to Improve Laboratory Safety Monitoring of Ongoing Drug Therapy in Ambulatory Patients

Raebel, Marsha A.; Chester, Elizabeth A.; Newsom, Elizabeth E; Lyons, Ella E.; Kelleher, Julia A; Long, Charron; Miller, Chad; Magid, David J.

doi:10.1592/phco.26.5.619

Cited by 41 publications

(41 citation statements)

References 19 publications

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“…4,[9][10][11][12] In a randomized intervention trial conducted during 2003 at one of the sites that participated in the current study, 15% of patients who were prescribed amiodarone and who received thyroid and/or aminotransferase laboratory testing as a result of the study intervention had abnormal test results. 33 There is the possibility that some patients were misclassified as continuing on amiodarone therapy. On the basis of the study definition of continuing dispensings, patients with as few as 2 dispensings of amiodarone in the 180-day dispensing period were included (Table 4).…”

Section: Accuracy Of Administrative Claims Data In Comparison To the mentioning

confidence: 99%

Liver and Thyroid Monitoring in Ambulatory Patients Prescribed Amiodarone in 10 HMOs

Raebel¹,

Carroll²,

Simon³

et al. 2006

JMCP

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he association between amiodarone and liver, thyroid, ocular, cardiac, skin, and pulmonary adverse events has been recognized for more than 20 years. [1][2][3][4][5][6][7][8] Asymptomatic elevation of liver enzymes occurs in 5%-24% of patients prescribed amiodarone, symptomatic liver injury occurs in up to 3%, 4,9 and thyroid dysfunction (including both hyper-and hypothyroidism) occurs in 2% to 24%. [10][11][12] Nearly all cases of liver and thyroid function abnormalities associated with amiodarone therapy are reversible with prompt recognition and management. If thyroid dysfunction occurs or if liver enzyme elevations exceed 3 times the upper limit of normal, the amiodarone dosage should be reduced or the drug discon-ABSTRACT BACKGROUND: Amiodarone can cause liver and thyroid toxicity, but little is known about compliance with laboratory tests to evaluate liver and thyroid function among ambulatory patients who are dispensed amiodarone.OBJECTIVES: The primary objective of this study was to identify the proportion of ambulatory patients who had liver aminotransferase and thyroid function tests during amiodarone therapy. Secondary objectives were to (1) describe factors associated with receipt of laboratory tests and (2) determine the accuracy of administrative data for assessing aminotransferase and thyroid function monitoring.METHODS: This retrospective cohort study was conducted at 10 health maintenance organizations (HMOs) for the dates of service from January 1, 1999, through June 30, 2001. Participants included 1,055 patients dispensed amiodarone for at least 180 days within this date range; these patients were not necessarily new starts on amiodarone. Administrative claims data were analyzed to assess the percentage of patients with completed alanine/aspartate aminotransferase and thyroid function tests. Depending on the HMO site, electronic or paper medical records were reviewed to evaluate the validity of administrative claims data. Logistic regression models were used to explore factors associated with receipt of laboratory tests.RESULTS: Both aminotransferase and thyroid function tests were completed in 53.3% of patients within a 210-day follow-up period that included the 180-day period of amiodarone dispensings plus 30 days. Thyroid function, with or without liver function (aminotransferase tests), was assessed in 61.9% of patients, and aminotransferase tests, with or without thyroid function, were assessed in 68.2% of patients. After adjusting for patient characteristics and site, the factor most strongly associated with having both types of laboratory tests evaluated was concomitant therapy with a statin (adjusted odds ratio (OR) 1.55; 95% confidence interval (CI), 1.05-2.29). Other factors associated with having both types of laboratory tests evaluated included the number of outpatient visits in the 6 months before the period of amiodarone dispensings (adjusted OR 1.06; 95% CI, 1.00-1.13 for each additional 5 visits) and living in a neighborhood where a higher median percentage of people had a hig...

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Section: Accuracy Of Administrative Claims Data In Comparison To the mentioning

confidence: 99%

Liver and Thyroid Monitoring in Ambulatory Patients Prescribed Amiodarone in 10 HMOs

Raebel¹,

Carroll²,

Simon³

et al. 2006

JMCP

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“…In addition to the sources for the Royal College of General Practitioners (RCGP) indicators, [3][4][5] a number of new key papers were found that were previously unknown to the authors (Table 1). [6][7][8][9][10][11]17 Over 600 prescribing indicators were reviewed against the inclusion and exclusion criteria, and against attributes of good indicators, including importance, validity, and feasibility of data collection using electronic health records. Exclusion criteria 1.…”

Section: Resultsmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11] Most of the indicator sets developed specifically for primary care originated in the UK. [12][13][14][15][16][17] Other methods of analysing prescribing also exist, for example, prescribing analysis and cost tabulation (PACT) data and the Medication Appropriateness Index (MAI).…”

Section: Introductionmentioning

confidence: 99%

Identification of an updated set of prescribing-safety indicators for GPs

et al. 2014

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“…3 Collaboration between pharmacists and physicians, in conjunction with an electronic alerting tool, increased the number of ambulatory patients receiving appropriate baseline laboratory monitoring for medications. 4 This expansion of pharmacy services has also been documented to improve patient outcomes. Pharmacist-managed aminoglycoside, vancomycin, and antiepileptic therapy has been associated with significantly improved economic and clinical outcomes in Medicare patients.…”

Section: Résultatsmentioning

confidence: 99%

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

LeBlanc¹,

Cameron-Coffill

Symes

et al. 2017

CJHP

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Randomized Trial to Improve Laboratory Safety Monitoring of Ongoing Drug Therapy in Ambulatory Patients

Abstract: A computerized tool plus collaboration of health care professionals effectively increased the number of patients who received laboratory safety monitoring of drug therapy.

Cited by 41 publications

References 19 publications

Liver and Thyroid Monitoring in Ambulatory Patients Prescribed Amiodarone in 10 HMOs

Liver and Thyroid Monitoring in Ambulatory Patients Prescribed Amiodarone in 10 HMOs

Identification of an updated set of prescribing-safety indicators for GPs

Implementation and Assessment of a Pharmacy Educational Program Concerning Laboratory Monitoring for Medications

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