Dataset Information

Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results.

ABSTRACT:

Background

Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers' ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) results, has not been widely studied.

Objective

To examine whether providers correctly interpret, document, and communicate LC-MS/MS UDT results.

Design

This is a retrospective chart review of 160 UDT results (80 aberrant; 80 non-aberrant) between August 2017 and February 2018 from 5 ambulatory clinics (3 primary care, 1 oncology, 1 pain management). Aberrant results were classified into one or more of the following categories: illicit drug use, simulated compliance, not taking prescribed medication, and taking a medication not prescribed. Accurate result interpretation was defined as concordance between the provider's documented interpretation and an expert laboratory toxicologist's interpretation. Outcome measures were concordance between provider and laboratory interpretation of UDT results, documentation of UDT results, results acknowledgement in the electronic health record, communication of results to the patient, and rate of prescription refills.

Key results

Aberrant results were most frequently due to illicit drug use. Overall, only 88 of the 160 (55%) had any documented provider interpretations of which 25/88 (28%) were discordant with the laboratory toxicologist's interpretation. Thirty-six of the 160 (23%) documented communication of the results to the patient. Communicating results was more likely to be documented if the results were aberrant compared with non-aberrant (33/80 [41%] vs. 3/80 [4%], p?ConclusionsErroneous provider interpretation of UDT results, infrequent documentation of interpretation, lack of communication of results to patients, and prescription refills despite inaccurate interpretations are common. Expert assistance with urine toxicology interpretations may be needed to improve provider accuracy when interpreting toxicology results.

SUBMITTER: Chua I

PROVIDER: S-EPMC6957646 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results.

Chua Isaac I Petrides Athena K AK Schiff Gordon D GD Ransohoff Jaime R JR Kantartjis Michalis M Streid Jocelyn J Demetriou Christiana A CA Melanson Stacy E F SEF

Journal of general internal medicine 20191111 1

<h4>Background</h4>Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers' ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) results, has not been widely studied.<h4>Objective</h4>To examine whether providers correctly interpret, document, and communicate LC-MS/MS UDT results.<h4>D ...[more]

PMID: 31713040

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Project description:Background and objectiveAegis Sciences Corporation developed a test (InterACT Rx™) that objectively and definitively identifies substances known to interact with drug-drug interaction-prone medications commonly prescribed in the treatment of chronic pain and behavioral health disorders. The objective of this study was to assess the severity of identified drug-drug interactions, the reduction in the frequency and severity of identified drug-drug interactions, and the impact of the test on healthcare utilization.MethodsPatients with chronic pain, behavioral health disorders, or both who had one or more drug-drug interaction tests and one or more drug-drug interactions identified in the study period were included. Drug-drug interaction test results described the number and severity of interactions and detected substances involved in drug-drug interactions. Patients' electronic medical records were obtained to analyze outpatient visits and prescription medications. The cost of outpatient visits was based on the Medicare Physician Fee Schedule. Outcomes were compared between the pre- and post-study index periods to determine the impact of the drug-drug interaction test on patient care.ResultsA total of 262 patients were included. The majority of drug-drug interactions detected (77.9%) at index were of moderate severity. The number of monthly all-cause and pain-related outpatient visits was reduced in the post-index period compared with the pre-index period (0.74-0.54 and 0.69-0.49, respectively). Associated costs were reduced from US$64.92 to US$51.20, and from US$62.42 to US$47.62, (p < 0.0001 for both) for all-cause and pain-related outpatient visits, respectively. Follow-up drug-drug interaction testing for 43 patients revealed that previously reported drug-drug interactions at the index test were no longer identified in the subsequent test for 39.5% of patients.ConclusionsEmploying a definitive test to detect substances whose interactions may cause adverse drug events can enhance a provider's insights, drive clinical decision making, and improve patient outcomes.

Dataset Information

Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results.

Background

Objective

Design

Key results

Publications

Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results.

Similar Datasets

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