Factors associated with ordering laboratory monitoring of high-risk medications.
Factors associated with ordering laboratory monitoring of high-risk medications.
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与对高风险药物进行实验室监测相关的因素。
DOI：
10.1007/s11606-014-2907-9
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发表时间：
2014
影响因子：
5.7
通讯作者：
Field,TerryS
中科院分区：
文献类型：
--
作者：
Fischer,ShiraH;Tjia,Jennifer;Reed,George;Peterson,Daniel;Gurwitz,JerryH;Field,TerryS
与供应商订购适当的测试相关的因素的知识是有限的。PROTETIVE确定医生因素与订购推荐的实验室监测测试high-risk medications.METHODSRetrospective队列研究的患者处方的高风险药物需要实验室监测在一个大型的多专业组的做法1月1日和2008年12月31日之间。分析基于行政索赔和电子病历。结果是医生对每种处方药的每种推荐实验室检查的医嘱。关键预测变量是医生特征，包括年龄、性别、专业培训、完成培训后的年数和处方量。其他变量是患者特征，如年龄、性别、合并症负担、需要监测的药物是新的还是慢性的，以及药物测试特征，如黑盒警告中的内容。我们使用多变量逻辑回归，解释了患者内药物和提供者内患者的聚集。在药物测试对之间，儿科医生对实验室测试的顺序不同，范围从9%（扑米酮-苯巴比妥水平）到97%（硫唑嘌呤-CBC），一半的药物测试对在85- 91%的顺序范围内。测试订购与研究药物的较高提供者处方量和专家状态相关（初级保健提供者订购测试的可能性低于专家）。合并症负担较高的患者和老年患者更有可能进行适当的检查。药物测试组合与黑框警告更有可能有测试ordered. CONCLUSIONSSInterventions，以改善实验室监测应集中在最有潜力的改善领域：供应商与较低频率的处方药物与监测建议和那些处方这些药物的健康和年轻的患者;与卫生保健系统互动较少的患者特别有可能没有安排检查。黑盒警告与较高的订购率相关，可能是增加适当测试订购的工具。
BACKGROUNDKnowledge about factors associated with provider ordering of appropriate testing is limited.OBJECTIVETo determine physician factors associated with ordering recommended laboratory monitoring tests for high-risk medications.METHODSRetrospective cohort study of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between 1 January 2008 and 31 December 2008. Analyses are based on administrative claims and electronic medical records. The outcome is a physician order for each recommended laboratory test for each prescribed medication. Key predictor variables are physician characteristics, including age, gender, specialty training, years since completing training, and prescribing volume. Additional variables are patient characteristics such as age, gender, comorbidity burden, whether the medication requiring monitoring is new or chronic, and drug-test characteristics such as inclusion in black box warnings. We used multivariable logistic regression, accounting for clustering of drugs within patients and patients within providers.RESULTSPhysician orders for laboratory testing varied across drug-test pairs and ranged from 9 % (Primidone–Phenobarbital level) to 97 % (Azathioprine–CBC), with half of the drug-test pairs in the 85-91 % ordered range. Test ordering was associated with higher provider prescribing volume for study drugs and specialist status (primary care providers were less likely to order tests than specialists). Patients with higher comorbidity burden and older patients were more likely to have appropriate tests ordered. Drug-test combinations with black box warnings were more likely to have tests ordered.CONCLUSIONSInterventions to improve laboratory monitoring should focus on areas with the greatest potential for improvement: providers with lower frequencies of prescribing medications with monitoring recommendations and those prescribing these medications for healthier and younger patients; patients with less interaction with the health care system are at particular risk of not having tests ordered. Black box warnings were associated with higher ordering rates and may be a tool to increase appropriate test ordering.
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DOI：
--
发表时间：
1980
期刊：
The Journal of biological chemistry
影响因子：
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作者：
Bregman,MD;Trivedi,D;Hruby,VJ
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DOI：
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发表时间：
1986
影响因子：
11.1
作者：
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2.9
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DOI：
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发表时间：
1979
期刊：
Biochimica et Biophysica Acta
影响因子：
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作者：
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