Laboratory tests recommended by pharmacists in a skilled-nursing facility

Pharmacists in healthcare settings often recommend laboratory tests to support patient care decisions. However, the extent to which these recommendations are accepted by physicians and their impact on treatment decisions remains unclear. Prior research has shown that pharmacists can identify drug-related issues through routine chart reviews, but the specific types of tests requested and their outcomes have not been widely documented. This gap motivated an investigation into the types of tests requested by pharmacists in a skilled-nursing facility and whether those tests led to changes in drug therapy. No prior work had resolved the relationship between pharmacist-recommended tests and physician acceptance rates or clinical outcomes. Understanding these factors could help improve interdisciplinary collaboration and patient safety. The study aimed to clarify the role of pharmacists in diagnostic decision-making. Establishing the frequency of test acceptance and outcomes could guide best practices in clinical pharmacy. The focus was on a skilled-nursing facility setting, where patients often require complex medication regimens. This context highlights the need for structured data on pharmacist-driven diagnostic testing.

The study aimed to evaluate the types of laboratory tests recommended by pharmacists in a skilled-nursing facility and determine how often physicians accepted those recommendations. It also sought to identify the reasons for the tests, their associated costs, and their clinical outcomes. The specific problem addressed was the lack of data on the impact of pharmacist-recommended tests on drug therapy decisions. The motivation for the study stemmed from the need to assess whether these tests contributed to improved patient care or unnecessary healthcare spending. By analyzing the outcomes of the tests, the researchers aimed to determine if the recommendations led to meaningful changes in treatment. The study focused on a 185-bed skilled-nursing facility, where patients often have multiple medications and complex health conditions. The goal was to provide evidence on the value of pharmacist involvement in diagnostic testing. This could inform future policies on pharmacist roles in clinical decision-making.

The study analyzed data collected from a computer database that recorded pharmacist-recommended laboratory tests from 1982 to 1987. Pharmacists routinely reviewed patient charts and entered relevant information into the database. The data included the type of test recommended, physician response to the recommendation, cost of the test, and the test outcome. Researchers categorized the types of tests and physician responses to determine acceptance rates. They also identified the reasons for recommending tests using the Department of Health and Human Services list of apparent irregularities related to drug therapy. The costs of the tests were calculated based on facility records. Outcomes were classified as either prompting a change in drug therapy or indicating that current therapy was appropriate. The study focused on 63 patients for whom 99 tests had been recommended. This approach allowed the researchers to assess the clinical utility of the tests and their acceptance by physicians.

Pharmacists requested 99 laboratory tests for 63 patients during the study period, and physicians accepted 87.9% of these requests. The most frequently requested tests were SMA-6, drug concentration tests, and anticoagulation studies. The primary reasons for recommending tests were routine monitoring, outdated results, suspected drug toxicity, and the need to decide on drug continuation. Of the 99 tests, 36 resulted in changes to drug therapy, while 56 indicated that current therapy was appropriate. The cost of the tests was not explicitly detailed in the abstract but was a focus of the study. The high acceptance rate suggests that physicians valued pharmacist recommendations. The most common outcome was that the tests confirmed the safety of ongoing treatment. The study found that pharmacist-recommended tests were often clinically relevant and led to actionable decisions. These findings suggest that pharmacist involvement in diagnostic testing can contribute to better patient outcomes.

The study found that pharmacist-recommended laboratory tests were frequently accepted by physicians and often led to changes in drug therapy. The authors concluded that these tests played a role in identifying drug-related issues and supporting clinical decisions. They proposed that pharmacist involvement in diagnostic testing could improve patient safety and care quality. The high acceptance rate of 87.9% indicated that physicians trusted the recommendations. The most common tests requested were SMA-6 and drug concentration studies, which are relevant to monitoring drug therapy. The authors suggested that these findings support the value of pharmacist contributions to patient care. They emphasized that the tests helped identify when therapy was appropriate or needed adjustment. The study did not propose new directions but highlighted the importance of pharmacist-physician collaboration in diagnostic decision-making.