血清地高辛浓度检测申请的质量：来自澳大利亚一个地区卫生服务机构的经验

Quality of requests for serum digoxin concentrations: experience from an Australian regional health service.

作者信息

Ellington Chris, Grgurinovich Nick, Miners John O, Mangoni Arduino A

机构信息

Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, SA, Australia.

出版信息

Br J Clin Pharmacol. 2007 May;63(5):623-7. doi: 10.1111/j.1365-2125.2006.02802.x. Epub 2006 Oct 30.

DOI:10.1111/j.1365-2125.2006.02802.x

PMID:17073890

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2000750/

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. * The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. * A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems.

WHAT THIS STUDY ADDS

The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. * Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings.

AIMS

To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service.

METHODS

We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice).

RESULTS

The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties).

CONCLUSIONS

The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed.

摘要

关于该主题的已知信息

血清地高辛浓度（SDC）的治疗药物监测被认为有助于提高地高辛的治疗效果，并将药物不良反应的发生率降至最低。
据报道，SDC检测申请的质量普遍不尽人意。然而，相关研究仅关注了少数信息参数。
更好地了解这些问题可能有助于找出医疗保健系统中存在的薄弱环节。

本研究的新增内容

SDC检测申请中的信息质量较差，涉及从申请人联系方式到地高辛最后一剂用药与采血时间间隔等一系列代码。
治疗药物监测服务的滥用在不同专科和医疗环境中普遍存在。

目的

评估某地区医疗服务机构的治疗药物监测服务收到的血清地高辛浓度（SDC）检测申请所提供信息的质量。

方法

我们对7个月期间连续收到的685份SDC检测申请进行了回顾性审核。审核了以下方面的信息：（i）联系方式；（ii）申请原因；（iii）剂量；（iv）给药途径；（v）联合治疗；（vi）治疗时长；（vii）最后一剂用药与采样的时间间隔，并将其编码为合适或不合适/缺失。根据申请来源进行数据分析，即来自不同专科/病房（急诊科和重症监护室、心脏病学和冠心病监护病房、内科和老年护理、外科以及普通/私人诊所）和医疗环境（教学医院、老年医院以及普通/私人诊所）。

结果

不同专科和医疗环境中，SDC检测申请的质量普遍较差。在所编码的参数中，提供的信息合适的比例仅为：（i）19.1%；（ii）6.4%；（iii）54.7%；（iv）45.8%；（v）12.8%；（vi）32.9%；（vii）47.1%。没有一份SDC检测申请在所有信息代码方面都是完整的。普通/私人诊所的SDC检测申请更常缺少剂量（46.7%的申请提供了信息，与其他专科相比，P = 0.007；与其他医疗环境相比，P = 0.02）和给药途径（20.0%，与其他专科和其他医疗环境相比，P < 0.001）方面的详细信息。急诊科和重症监护室的SDC检测申请更常缺少治疗时长（22.6%，与其他专科相比，P < 0.001）和最后一剂用药与采血时间间隔（40.1%，与其他专科相比，P = 0.01）方面的详细信息。