Routine laboratory tests: helpful or just costly?

Area of Science:

• Geriatric Pharmacy
• Clinical Laboratory Science
• Pharmacoeconomics

Background:

• Appropriate utilization of laboratory tests is crucial for effective patient care, particularly in geriatric settings.
• Underuse of specific tests (e.g., drug levels, renal function) can lead to suboptimal therapeutic outcomes.
• Overuse of routine laboratory monitoring can result in significant, unnecessary healthcare expenditures.

Purpose of the Study:

• To evaluate the utilization of laboratory tests in a geriatric nursing home setting.
• To assess the impact of consultant pharmacist recommendations on laboratory test ordering and drug therapy.
• To determine the cost-effectiveness of appropriate laboratory test utilization versus routine, excessive monitoring.

Main Methods:

• A consultant pharmacist conducted a two-year study in a 72-bed geriatric nursing home.
• Evaluated underutilization of drug levels (digoxin, phenytoin, theophylline), serum electrolytes, and serum creatinine.
• Tracked prescriber acceptance of recommendations and subsequent changes in drug therapy and associated costs.

Main Results:

• 95% prescriber acceptance of pharmacist recommendations for lab monitoring led to drug therapy changes in 87.5% of cases.
• 32 of 35 authorized lab tests resulted in significant changes to drug therapy (dose, schedule, or additional therapy).
• Optimized lab ordering cost $2,560, while excessive routine monitoring incurred $71,566 in unnecessary costs over two years.

Conclusions:

• Targeted laboratory test utilization, guided by clinical pharmacist expertise, significantly improves drug therapy management in geriatric nursing homes.
• Implementing appropriate lab monitoring protocols can lead to substantial cost savings by avoiding unnecessary testing.
• The study highlights the value of pharmacist-led interventions in optimizing diagnostic testing and healthcare resource allocation.