TY - JOUR
KW - Adult
KW - Aged
KW - Baltimore
KW - Community Health Centers/organization & administration/statistics & numerical data
KW - Drug Monitoring/methods
KW - Drug Toxicity/epidemiology/prevention & control
KW - Female
KW - Humans
KW - Insurance Coverage/statistics & numerical data
KW - Insurance, Health/statistics & numerical data
KW - Male
KW - Medical Records Systems, Computerized/statistics & numerical data
KW - Middle Aged
KW - Primary Health Care/statistics & numerical data
AU - D. G. Bundy
AU - J. A. Marsteller
AU - A. W. Wu
AU - L. D. Engineer
AU - S. M. Berenholtz
AU - A. H. Caughey
AU - D. Silver
AU - J. Tian
AU - R. E. Thompson
AU - M. R. Miller
AU - C. U. Lehmann
A1 - 
AB - BACKGROUND: Timely laboratory monitoring may reduce the potential harm associated with chronic medication use. A study was conducted to determine the proportion of patients receiving National Committee for Quality Assurance (NCQA)-recommended laboratory medication monitoring in a primary care setting and to assess the effect of electronic health record (EHR)-derived, paper-based, provider-specific feedback bulletins on subsequent patient receipt of medication monitoring. METHODS: In a single-arm, pre-post intervention in two federally qualified community health centers in Baltimore, patients targeted were adults prescribed at least 6 months (in the preceding year) for at least one index medication (digoxin, statins, diuretics, angiotensin-converting enzyme inhibitors/ angiotensin II-receptor blockers) in a 12-month period (August 2008-July 2009). RESULTS: Among the 2,013 patients for whom medication monitoring was recommended, 42% were overdue for monitoring at some point during the study. As the number of index medications the patient was prescribed increased, the likelihood of ever being overdue for monitoring decreased. Being listed on the provider-specific monitoring bulletin doubled the odds of a patient receiving recommended laboratory monitoring before the next measurement period (1-2 months). Limiting the intervention to the most overdue patients, however, mitigated its overall impact. CONCLUSIONS: Recommended laboratory monitoring of chronic medications appears to be inconsistent in primary care, resulting in potential harm for individuals at risk for medication-related toxicity. EHRs may be an important component of systems designed to improve medication monitoring, but multimodal interventions will likely be needed to achieve high reliability.
BT - Joint Commission journal on quality and patient safety / Joint Commission Resources
C5 - HIT & Telehealth
CP - 5
CY - United States
IS - 5
JF - Joint Commission journal on quality and patient safety / Joint Commission Resources
N2 - BACKGROUND: Timely laboratory monitoring may reduce the potential harm associated with chronic medication use. A study was conducted to determine the proportion of patients receiving National Committee for Quality Assurance (NCQA)-recommended laboratory medication monitoring in a primary care setting and to assess the effect of electronic health record (EHR)-derived, paper-based, provider-specific feedback bulletins on subsequent patient receipt of medication monitoring. METHODS: In a single-arm, pre-post intervention in two federally qualified community health centers in Baltimore, patients targeted were adults prescribed at least 6 months (in the preceding year) for at least one index medication (digoxin, statins, diuretics, angiotensin-converting enzyme inhibitors/ angiotensin II-receptor blockers) in a 12-month period (August 2008-July 2009). RESULTS: Among the 2,013 patients for whom medication monitoring was recommended, 42% were overdue for monitoring at some point during the study. As the number of index medications the patient was prescribed increased, the likelihood of ever being overdue for monitoring decreased. Being listed on the provider-specific monitoring bulletin doubled the odds of a patient receiving recommended laboratory monitoring before the next measurement period (1-2 months). Limiting the intervention to the most overdue patients, however, mitigated its overall impact. CONCLUSIONS: Recommended laboratory monitoring of chronic medications appears to be inconsistent in primary care, resulting in potential harm for individuals at risk for medication-related toxicity. EHRs may be an important component of systems designed to improve medication monitoring, but multimodal interventions will likely be needed to achieve high reliability.
PP - United States
PY - 2012
SN - 1553-7250; 1553-7250
SP - 216
EP - 223
EP - 
T1 - Electronic health record-based monitoring of primary care patients at risk of medication-related toxicity
T2 - Joint Commission journal on quality and patient safety / Joint Commission Resources
TI - Electronic health record-based monitoring of primary care patients at risk of medication-related toxicity
U1 - HIT & Telehealth
U2 - 22649861
VL - 38
VO - 1553-7250; 1553-7250
Y1 - 2012
ER -