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    Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees.

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    Authors
    Simon, Steven R.
    Andrade, Susan E.
    Ellis, Jennifer L.
    Nelson, Winnie W.
    Gurwitz, Jerry H.
    Lafata, Jennifer Elston
    Davis, Robert L.
    Feldstein, Adrianne
    Raebel, Marsha A.
    UMass Chan Affiliations
    Department of Medicine, Division of Geriatric Medicine
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2005-12-01
    Keywords
    Aged
    Aged, 80 and over
    Cardiovascular Agents
    Cardiovascular Diseases
    Comorbidity
    Cross-Sectional Studies
    Drug Monitoring
    Female
    Health Maintenance Organizations
    Humans
    Laboratory Techniques and Procedures
    Logistic Models
    Male
    Medication Errors
    Risk Factors
    United States
    Health Services Research
    Medicine and Health Sciences
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    Link to Full Text
    http://dx.doi.org/10.1111/j.1532-5415.2005.00498.x
    Abstract
    OBJECTIVES: To identify correlates of laboratory monitoring errors in elderly health maintenance organization (HMO) members at the initiation of therapy with cardiovascular medications. DESIGN: Cross-sectional study in 10 HMOs. SETTING: United States. PARTICIPANTS: From a 2 million-member sample, individuals aged 65 and older who received one of seven cardiovascular medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), amiodarone, digoxin, diuretics, potassium supplements, and statins) and did not have recommended baseline monitoring performed during the 180 days before or 14 days after the index dispensing. MEASUREMENTS: The proportion of members receiving each drug for whom recommended laboratory monitoring was not performed. Laboratory monitoring error rates stratified by sex, age group, chronic disease score, and HMO site were examined, and logistic regression was used to identify predictors of laboratory monitoring errors. RESULTS: Error rates varied by medication class, ranging from 23% of patients receiving potassium supplementation without serum potassium and serum creatinine monitoring to 58% of patients receiving amiodarone who did not have recommended monitoring for thyroid and liver function. Highest error rates occurred in the youngest elderly for ACE inhibitors, ARBs, digoxin, diuretics, and potassium supplements, although in patients receiving amiodarone and statins, errors were most frequent in the oldest elderly. Errors occurred more frequently in patients with less comorbidity. CONCLUSION: Laboratory monitoring errors occurred frequently in elderly HMO members at the initiation of therapy with cardiovascular medications. Further study must examine the association between these errors and adverse outcomes.
    Source
    J Am Geriatr Soc. 2005 Dec;53(12):2165-9.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37164
    PubMed ID
    16398903; 16398903
    Related Resources
    Link to article in PubMed
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    UMass Chan Faculty and Researcher Publications

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