Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results
Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results
复制标题
DOI：
10.1007/s11606-019-05514-5
复制
发表时间：
2019-11-11
影响因子：
5.7
通讯作者：
Melanson, Stacy E. F.
中科院分区：
文献类型：
--
作者：
Chua, Isaac;Petrides, Athena K.;Melanson, Stacy E. F.
尿药物检测（UDT）是监测长期阿片类药物治疗患者阿片类药物滥用的重要工具。对UDT的不准确解释可能会产生有害后果。供应商准确解释和记录UDT，特别是确定性液相色谱-串联质谱（LC-MS/MS）结果的能力尚未得到广泛研究。目的检查供应商是否正确解释、记录和传达LC-MS/MS UDT结果。设计这是对2017年8月至2018年2月期间来自5个门诊诊所（3个初级保健，1个肿瘤学，1个疼痛管理）的160个UDT结果（80个异常; 80个非异常）的回顾性图表审查。异常结果分为以下一个或多个类别：非法药物使用，模拟依从性，不服用处方药，服用非处方药。准确的结果解释被定义为提供者的记录解释和专家实验室毒理学家的解释之间的一致性。结局指标为提供者和实验室对UDT结果的解释之间的一致性、UDT结果的记录、电子健康记录中的结果确认、将结果传达给患者以及处方续药率。主要结果异常结果最常见的是由于非法药物的使用。总体而言，160例中只有88例（55%）记录了供应商的解释，其中25/88例（28%）与实验室毒理学家的解释不一致。160例中的36例（23%）记录了与患者的结果沟通。与非异常结果相比，如果结果异常，则更有可能记录传达结果（33/80 [41%] vs. 3/80 [4%]，p < 0.001）。在提供者解释与实验室解释不一致的所有情况下，重新填写处方。结论提供者对UDT结果的错误解释，解释的不频繁记录，缺乏与患者的结果沟通，以及尽管解释不准确，但处方续药是常见的。在解释毒理学结果时，可能需要尿液毒理学解释的专家协助，以提高提供者的准确性。
Background Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers' ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) results, has not been widely studied. Objective To examine whether providers correctly interpret, document, and communicate LC-MS/MS UDT results. Design This is a retrospective chart review of 160 UDT results (80 aberrant; 80 non-aberrant) between August 2017 and February 2018 from 5 ambulatory clinics (3 primary care, 1 oncology, 1 pain management). Aberrant results were classified into one or more of the following categories: illicit drug use, simulated compliance, not taking prescribed medication, and taking a medication not prescribed. Accurate result interpretation was defined as concordance between the provider's documented interpretation and an expert laboratory toxicologist's interpretation. Outcome measures were concordance between provider and laboratory interpretation of UDT results, documentation of UDT results, results acknowledgement in the electronic health record, communication of results to the patient, and rate of prescription refills. Key Results Aberrant results were most frequently due to illicit drug use. Overall, only 88 of the 160 (55%) had any documented provider interpretations of which 25/88 (28%) were discordant with the laboratory toxicologist's interpretation. Thirty-six of the 160 (23%) documented communication of the results to the patient. Communicating results was more likely to be documented if the results were aberrant compared with non-aberrant (33/80 [41%] vs. 3/80 [4%], p < 0.001). In all cases where provider interpretations were discordant with the laboratory interpretation, prescriptions were refilled. Conclusions Erroneous provider interpretation of UDT results, infrequent documentation of interpretation, lack of communication of results to patients, and prescription refills despite inaccurate interpretations are common. Expert assistance with urine toxicology interpretations may be needed to improve provider accuracy when interpreting toxicology results.