Patient Completion of Laboratory Tests to Monitor Medication Therapy: A Mixed-Methods Study

Abstract

BACKGROUND:Little is known about the contribution of patient behavior to incomplete laboratory monitoring, and the reasons for patient non-completion of ordered laboratory tests remain unclear. OBJECTIVE: To describe factors, including patientreported reasons, associated with non-completion of ordered laboratory tests. DESIGN: Mixed-Methods study including a quantitative assessment of the frequency of patient completion of ordered monitoring tests combined with qualitative, semi-structured, patient interviews. PARTICIPANTS: Quantitative assessment included patients 18 years or older from a large multispecialty group practice, who were prescribed a medication requiring monitoring. Qualitative interviews included a subset of show and no-show patients prescribed a cardiovascular, anticonvulsant, or thyroid replacement medication. MAIN MEASURES: Proportion of recommended monitoring tests for each medication not completed, factors associated with patient non-completion, and patientreported reasons for non-completion. KEY RESULTS: Of 27,802 patients who were prescribed one of 34 medications, patient non-completion of ordered tests varied (range: 0-24 %, by drug-test pair). Factors associated with higher odds of test noncompletion included: younger patient age (< 40 years vs. ≥ 80 years, adjusted odds ratio [AOR] 1.52, 95 % confidence interval [95 % CI] 1.27-1.83); lower medication burden (one medication vs. more than one drug, AOR for non-completion 1.26, 95 % CI 1.15-1.37), and lower visit frequency (0-5 visits/year vs. ≥ 19 visits/ year, AOR 1.41, 95 % CI 1.25 to 1.59). Drug-test pairs with black box warning status were associated with greater odds of non-completion, compared to drugs without a black box warning or other guideline for testing (AOR 1.91,. Qualitative interviews, with 16 no-show and seven show patients, identified forgetting as the main cause of non-completion of ordered tests. CONCLUSIONS:Patient non-completion contributed to missed opportunities to monitor medications, and was associated with younger patient age, lower medication burden and black box warning status. Interventions to improve laboratory monitoring should target patients as well as physicians.

Primary care provider perceptions of enablers and barriers to following guideline-recommended laboratory tests to confirm chronic kidney disease: a qualitative descriptive study

“…Finally, previous studies on primary care providers’ perceived enablers and barriers to ordering laboratory tests in general have also identified that a barrier is patients not completing the laboratory test [ 37 , 40 ]. A mixed methods study on patient perceived barriers to not completing a laboratory test after initiating a new medication that required monitoring included barriers of forgetting or competing demands [ 41 ]. Since our study only included the primary care provider perspective, we cannot make any conclusions about the applicability of these patient-specified barriers to completing a repeat serum creatinine test.…”

Prescriptive variability of drugs by general practitioners

“…Better efficiency and appropriateness in prescribing practice could be achieved by addressing the over- or under-utilisation of drugs. It was shown that prescribed medications are often taken for long periods beyond the point when they are needed and around 30% of drugs are abandoned by patients [ 22 – 25 ]. Major NHS savings could also be generated by using treatments that are most cost-effective.…”

Factors Associated with Hyponatremia in Patients Newly Prescribed Citalopram: A Retrospective Observational Study

“…The frequency of diagnostic laboratory testing increases with age, since the likelihood of comorbidity and polypharmacy also increase with age. Older patients tend to have more contact with their healthcare providers, and thus are more likely to complete laboratory testing than those younger in age [ 47 ]. Polypharmacy further increases the risk of adverse drug interactions; therefore, patients on high-risk medications, and also those on thiazide diuretics, are significantly more likely to complete regular testing as well [ 47 , 48 ].…”