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A utilization review of theophylline assays: sampling patterns and use
Drug Intelligence & Clinical Pharmacy
|November 1, 1984
Summary
Theophylline assay use in hospitals is often suboptimal, with low compliance rates and significant financial waste. Improving assay utilization requires better physician guidance and potentially a dedicated pharmacokinetics service.
Area of Science:
- Clinical Chemistry
- Pharmacokinetics
- Health Services Research
Background:
- Theophylline is a critical medication for respiratory conditions.
- Effective therapeutic drug monitoring is essential for optimizing theophylline efficacy and safety.
- Previous studies highlight variability in laboratory assay utilization.
Purpose of the Study:
- To audit theophylline assay utilization in hospitalized patients.
- To identify areas of non-compliance with established audit criteria.
- To estimate the financial impact of inappropriate theophylline assay use.
Main Methods:
- A two-month audit of theophylline assays in 121 inpatients at a university medical center.
- Daily chart review collecting data on pulmonary function, blood gases, liver function, vital signs, and physician assessments.
- Adaptation of published audit criteria for assay collection and use.
Main Results:
- Only 29.8% of theophylline assay evaluations met all audit criteria.
- Compliance rates for rational indication, correct performance, and dosage adjustment were 69.1%, 72.3%, and 67.2%, respectively.
- Physician instructions for assay timing were inadequate in 48.6% of cases, leading to potential collection errors.
Conclusions:
- Significant deficiencies exist in theophylline assay utilization, impacting patient care and resource allocation.
- Inadequate physician guidance for assay collection is a major contributing factor to non-compliance.
- Estimated annual hospital laboratory charges for inappropriate theophylline assays exceed $77,000, underscoring the need for improved processes and potential pharmacokinetics service reimbursement.
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