Routine laboratory tests: helpful or just costly?

J W Cooper
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Abstract

The appropriate utilization of laboratory tests was studied by a consultant pharmacist in a 72-bed geriatric nursing home over a two-year period. There was a general underutilization of drug levels to detect digoxin, phenytoin, and theophylline effects; and occasional underuse of serum electrolytes and serum creatinine to monitor diuretic effects and determine appropriate use of drugs in renal impairment. Prescriber acceptance of 95 percent (40 of 42) consultant pharmacist recommendations for lab monitoring brought changes in drug therapy with 35 of 40 cases (87.5 percent). Thirty-two of 35 (91.4 percent) prescriber-authorized lab determinations resulted in significant results that changed drug therapy dose, schedule, or necessitated additional therapy. The total cost of the requested lab work was $2,560 over the two-year study period. On the other hand, the overuse of routine multiple lab tests on a monthly to bimonthly basis yielded new information in less than five percent of repeated determinations. Routine lab work, which was in excess of the federal "indicators" frequency and situation recommendations, produced $71,566 of excessive and perhaps unnecessary health-care costs over the two-year period.

常规实验室检查:有用还是昂贵?
一名顾问药剂师在一家有72张床位的老年疗养院进行了为期两年的实验室检查的适当利用研究。在检测地高辛、苯妥英和茶碱效应方面,药物水平的利用普遍不足;偶尔不充分使用血清电解质和血清肌酐来监测利尿作用和确定肾损害患者药物的适当使用。处方者接受95%(42例中的40例)的咨询药师对实验室监测的建议带来了药物治疗的改变,40例中有35例(87.5%)。35个处方授权的实验室检测中有32个(91.4%)产生了显著的结果,改变了药物治疗剂量、计划或需要额外的治疗。在两年的研究期间,所要求的实验室工作的总费用为2 560美元。另一方面,在每月到两个月的基础上过度使用常规的多个实验室测试,在不到5%的重复测定中产生新的信息。常规的实验室工作超出了联邦"指标"频率和情况建议,在两年期间产生了71,566美元的过度和可能不必要的保健费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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