Beth Israel Deaconess Medical Center, Division of Clinical Informatics, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.
J Gen Intern Med. 2013 Apr;28(4):513-21. doi: 10.1007/s11606-012-2271-6. Epub 2012 Nov 15.
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.
To describe factors, including patient-reported reasons, associated with non-completion of ordered laboratory tests.
Mixed-Methods study including a quantitative assessment of the frequency of patient completion of ordered monitoring tests combined with qualitative, semi-structured, patient interviews.
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.
Proportion of recommended monitoring tests for each medication not completed, factors associated with patient non-completion, and patient-reported reasons for non-completion.
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 non-completion 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, 95 % CI 1.66-2.19). Qualitative interviews, with 16 no-show and seven show patients, identified forgetting as the main cause of non-completion of ordered tests.
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.
关于患者行为对实验室监测不完整的影响，以及患者未完成医嘱实验室检查的原因尚不清楚。
描述与未完成医嘱实验室检查相关的因素，包括患者报告的原因。
包括定量评估患者完成医嘱监测检查的频率，以及定性、半结构化、患者访谈的混合方法研究。
定量评估纳入了一家大型多专科实践的 18 岁及以上患者，这些患者被开具了需要监测的药物。定性访谈包括开具心血管、抗惊厥或甲状腺替代药物的有或无预约患者的一个亚组。
每种药物的推荐监测试验中未完成的比例、与患者未完成相关的因素以及患者未完成的原因。
在 27802 名被开具 34 种药物之一的患者中，医嘱实验室检查的未完成率存在差异（范围：0-24%，按药物-检查对）。与检查未完成的可能性更高相关的因素包括：更年轻的患者年龄（<40 岁与≥80 岁相比，调整后的优势比 [OR] 1.52，95%置信区间 [95%CI] 1.27-1.83）；较低的药物负担（一种药物与多种药物相比，未完成的 OR 为 1.26，95%CI 为 1.15-1.37），以及较低的就诊频率（0-5 次就诊/年与≥19 次就诊/年相比，OR 为 1.41，95%CI 为 1.25-1.59）。与无黑框警告或其他检查指南的药物相比，具有黑框警告状态的药物-检查对与更高的未完成率相关（OR 1.91，95%CI 1.66-2.19）。对 16 名失约患者和 7 名如约患者的定性访谈发现，忘记是未完成医嘱实验室检查的主要原因。
患者未完成检查导致监测药物的机会丧失，与患者年龄较小、药物负担较低和黑框警告状态有关。改善实验室监测的干预措施应针对患者和医生。
