Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States.
Clin Chim Acta. 2014 Jan 1;427:158-66. doi: 10.1016/j.cca.2013.09.039. Epub 2013 Sep 30.
Recent upward trends in the prevalence of abuse of prescription drugs and illicit substances have resulted in increased demands for toxicology testing to support the emergency department and drug treatment in pain management programs. This review will discuss the challenges faced by clinical laboratories to manage the utilization of toxicology tests, particularly those ordered in managing poisoned patients in the emergency department and chronic pain patients on opioid therapy. Optimal utilization of toxicology tests to support the emergency department relies on selecting the appropriate tests for the patient, and the availability of the results in a timely fashion. Two tiers of toxicology testing systems with different requirements for turnaround time will be discussed. In patients with chronic pain urine drug testing, including screening and confirmation testing are used extensively in pain management to monitor patient compliance. A thorough understanding of the performance characteristics of the test methodologies and drug metabolism is a key to making a proper analytical and clinical interpretation of the test results and will contribute to effective utilization of these tests. In addition, the reimbursement system is an important factor in the decision making process for test selection utilization as significant costs can be incurred by both payers and patients. Collaboration, trust, and effective communication among clinicians, patients, and clinical laboratory professionals are essential for effective utilization of toxicology testing.
近年来，处方药物和非法物质滥用的流行率呈上升趋势，这导致对毒理学检测的需求增加，以支持急诊科和疼痛管理项目中的药物治疗。本文将讨论临床实验室在管理毒理学检测的应用方面所面临的挑战，特别是在急诊科处理中毒患者和接受阿片类药物治疗的慢性疼痛患者时。为了支持急诊科的最佳毒理学检测应用，需要根据患者的情况选择合适的检测，并及时获得检测结果。本文将讨论两种毒理学检测系统，它们对周转时间有不同的要求。对于慢性疼痛患者，尿液药物检测（包括筛查和确证检测）在疼痛管理中广泛用于监测患者的依从性。全面了解测试方法和药物代谢的性能特征是对测试结果进行适当分析和临床解读的关键，有助于有效利用这些测试。此外，报销制度是测试选择利用决策过程中的一个重要因素，因为支付方和患者都会产生大量费用。临床医生、患者和临床实验室专业人员之间的协作、信任和有效沟通对于毒理学检测的有效利用至关重要。
