Academic Detailing to Improve Laboratory Testing Among Outpatient Medication Users

Datos Bibliográficos

ID9104610
AutoresJennifer Elston Lafata (0000-0002-8550-6195, Henry Ford Health System), Margaret J Gunter (Lovelace Clinic Foundation Research), John Hsu (0000-0001-8244-231X, Kaiser Permanente), Scott Kaatz (0000-0002-3080-3328, Henry Ford Health System, autor de correspondencia), Richard Krajenta, Richard Platt (0000-0002-3248-3583, Harvard University), Lonni Schultz, Joseph V Selby (Kaiser Permanente), Steven R Simon (0000-0002-4624-4364, Harvard University), Jan Simpkins, Stephen B Soumerai (0000-0001-6811-2496, Harvard University), Connie S Uratsu (0000-0001-9870-138X, Kaiser Permanente), Connie Uratsu
Año2007
Volumen45
Número10
Páginas966-972
Fecha de publicación2007-10-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3180546856
PMID17890994
OpenAlexW2029421943
IdiomaEN
Referencias citadas27

PURPOSE: To determine whether group academic detailing with performance feedback increases recommended laboratory monitoring among outpatients dispensed medications. METHODS: Thirty-eight primary care practices in 3 states were randomized to group academic detailing with physician-level performance feedback (intervention) or a control group. Adjusted differences in creatinine and potassium testing between intervention and control group patients with a new or continuing dispensing for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), diuretics, or digoxin were evaluated using generalized estimating equation approaches. RESULTS: Monitoring among patients with an initial ACE/ARB and diuretic dispensing significantly improved with the intervention [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.08-1.38; and OR = 1.25, 95% CI: 1.08-1.44, respectively). The intervention also significantly improved monitoring among patients with a continuing dispensing for an ACE/ARB (OR = 1.39, 95% CI: 1.11-1.74) or a diuretic (OR = 1.28, 95% CI: 1.02-1.60). Adjusted differences in testing rates between study arms were modest (ranging from 2.5% to 4.9%). No significant differences in monitoring by study arm were detected among patients dispensed digoxin. CONCLUSIONS: The impact of a group academic detailing program with feedback on recommended laboratory monitoring among medication users was modest. Yet, given the numbers of outpatients dispensed medications for which laboratory monitoring is recommended, group academic detailing may offer 1 method by which outpatient medication safety can be significantly improved

Family medicine · MEDLINE · Clinical Laboratory Practices and Quality Control · Medicine · Meta-analysis and systematic reviews · Psychology · Reliability and Agreement in Measurement