Academic detailing to improve laboratory testing among outpatient medication users

Area of Science:

• Clinical Pharmacy
• Health Services Research
• Patient Safety

Background:

• Outpatient medication use requires regular laboratory monitoring to ensure safety and efficacy.
• Physician performance feedback and academic detailing are strategies to improve clinical practice.
• Assessing the impact of interventions on monitoring rates for specific drug classes is crucial.

Purpose of the Study:

• To evaluate if group academic detailing with performance feedback enhances recommended laboratory monitoring for outpatients.
• To assess the effect of the intervention on creatinine and potassium testing rates.

Main Methods:

• A randomized controlled trial involving 38 primary care practices across 3 states.
• Intervention group received group academic detailing with physician-level performance feedback.
• Generalized estimating equation models analyzed differences in lab testing for specific medications (ACE inhibitors/ARBs, diuretics, digoxin).

Main Results:

• Significant improvements in monitoring were observed for initial dispensing of ACE inhibitors/ARBs and diuretics.
• Continuing dispensing of ACE inhibitors/ARBs and diuretics also showed improved monitoring rates.
• Differences in testing rates were modest (2.5%-4.9%); no significant impact on digoxin monitoring.

Conclusions:

• Group academic detailing with feedback had a modest impact on laboratory monitoring for medication users.
• Despite modest effects, this intervention offers a potential method to improve outpatient medication safety.
• The findings highlight the importance of targeted interventions for improving adherence to monitoring guidelines.