Featured Research

from universities, journals, and other organizations

Lab monitoring tests not always ordered per recommendations

Date:
June 26, 2014
Source:
Springer
Summary:
Why does one physician in a walk-in practice order laboratory monitoring tests for patients more often than a colleague working down the hallway? Which factors influence the use of these important tests? Clues to these questions lie in the age and general health of the patient, and whether the doctor is a specialist or not, says the lead author of a study.

Why does one physician in a walk-in practice order laboratory monitoring tests for patients more often than a colleague working down the hallway? Which factors influence the use of these important tests that can help doctors ensure that high-risk drugs are prescribed safely? Clues to these questions lie in the age and general health of the patient, and whether the doctor is a specialist or not, says Shira Fischer of the Beth Israel Deaconess Medical Center in Boston. She is the lead author of a study which appears in the Journal of General Internal Medicine, published by Springer.

Laboratory tests help doctors to monitor the condition of their patients, and to ensure that prescribed drugs work effectively and safely in treating high-risk conditions. However, these are not always performed, even in cases where such tests are advised before a new round of medicines can be dispensed. This can lead to medical errors and influence patient safety, as was highlighted in the US Institute of Medicine's report "To Err is Human."

There are no US national guidelines about appropriate laboratory monitoring, and experts do not agree on the appropriate standards of monitoring.To ascertain the factors that influence how and when physicians order laboratory tests, Fischer and her colleagues conducted research at the Meyers Primary Care Institute in Massachusetts, studying the electronic medical records of 31,417 patients and 278 providers in a large multispecialty New England group practice.

The study includes information about prescriptions for 34 high-risk conditions and their 60 associated tests. For recommended tests, the rate of physician ordering varies greatly, with for example almost all patients taking potassium receiving an order for a potassium level (95 percent) but less than half of patients on Lithium receiving orders for a blood count (42 percent) or creatinine level (49 percent), as is recommended.

Tests measured yearly (for example, Digoxin level) were more likely to be ordered than those required more often (for example, AST/ALT levels in patients on Rifampin). Specialists are more likely to order the recommended tests for the medications used in the study than primary care providers. Older patients, men and people already using other medications are also tested more regularly. Younger patients and people who do not often visit doctors seldom received test orders. Younger physicians and those who are familiar with the testing guidelines associated with a specific medication are also more likely to use laboratory tests to monitor their patients.

The researchers also found that the so-called "black box warnings" on certain medications regularly alert practitioners to the need to run associated tests. These warnings can be required by the US Food and Drug Administration and are the strongest ones around in prescription drug labeling. Even so, not everyone takes heed of them. "Interventions to improve laboratory monitoring should focus on areas with the greatest potential for improvement, such as providers who do not prescribe medication much, or those who prescribe medication to healthier and younger patients, or once-off walk-in patients," advises Fischer, who believes it is worthwhile to provide "black box warnings" on medications shown to be highest-risk to educate physicians about the importance of laboratory monitoring.


Story Source:

The above story is based on materials provided by Springer. Note: Materials may be edited for content and length.


Journal Reference:

  1. Shira H. Fischer, Jennifer Tjia, George Reed, Daniel Peterson, Jerry H. Gurwitz, Terry S. Field. Factors Associated with Ordering Laboratory Monitoring of High-Risk Medications. Journal of General Internal Medicine, 2014; DOI: 10.1007/s11606-014-2907-9

Cite This Page:

Springer. "Lab monitoring tests not always ordered per recommendations." ScienceDaily. ScienceDaily, 26 June 2014. <www.sciencedaily.com/releases/2014/06/140626121958.htm>.
Springer. (2014, June 26). Lab monitoring tests not always ordered per recommendations. ScienceDaily. Retrieved October 1, 2014 from www.sciencedaily.com/releases/2014/06/140626121958.htm
Springer. "Lab monitoring tests not always ordered per recommendations." ScienceDaily. www.sciencedaily.com/releases/2014/06/140626121958.htm (accessed October 1, 2014).

Share This



More Health & Medicine News

Wednesday, October 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Pregnancy Spacing Could Have Big Impact On Autism Risks

Pregnancy Spacing Could Have Big Impact On Autism Risks

Newsy (Oct. 1, 2014) A new study says children born less than one year and more than five years after a sibling can have an increased risk for autism. Video provided by Newsy
Powered by NewsLook.com
Robotic Hair Restoration

Robotic Hair Restoration

Ivanhoe (Oct. 1, 2014) A new robotic procedure is changing the way we transplant hair. The ARTAS robot leaves no linear scarring and provides more natural results. Video provided by Ivanhoe
Powered by NewsLook.com
Insertable Cardiac Monitor

Insertable Cardiac Monitor

Ivanhoe (Oct. 1, 2014) A heart monitor the size of a paperclip that can save your life. The “Reveal Linq” allows a doctor to monitor patients with A-Fib on a continuous basis for up to 3 years! Video provided by Ivanhoe
Powered by NewsLook.com
Attacking Superbugs

Attacking Superbugs

Ivanhoe (Oct. 1, 2014) Two weapons hospitals can use to attack superbugs. Scientists in Ireland created a new gel resistant to superbugs, and a robot that can disinfect a room in minutes. Video provided by Ivanhoe
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins