Abstract
Background/Aims Inadequate laboratory monitoring of high-risk medications is a medical error associated with preventable adverse drug events. Patient failure to complete ordered laboratory tests is not uncommon. We conducted in-depth interviews with patients who did not complete a recently ordered laboratory test to identify barriers to test completion.
Methods The target population was patients in a large multispecialty group practice who failed to complete an ordered laboratory test. We conducted semi-structured interviews with 18 patients who did not complete a monitoring test order related to 1 of 7 high-risk medications (angiotensin converting enzyme inhibitors (ACE) inhibitors, angiotensin II receptor blockers (ARBs), digoxin, phenytoin, statins, thyroid replacement hormone, or valproic acid) between July 2008 and October 2010. For comparison, we also interviewed 5 patients who completed all ordered laboratory tests. The interviews occurred in person when possible (n=17) as well as by phone (n=6). All interviews were recorded and transcribed and analyzed using a grounded theory approach.
Results The laboratory monitoring discussions included the following themes: physician communication about lab tests, patient comprehension of lab test purpose, patient attitude toward lab tests, and barriers to test completion. The most prominent barrier to test completion was forgetting. Patients often did not realize they had missed an ordered test. When patients did acknowledge missing an ordered test, they often noted that they did not encounter any barriers besides forgetting. Regarding potential interventions, patients reported that understanding the indication for the tests would not help reduce non-completion. Several patients understood the reason for the test, but still failed to complete it. While some thought it was important to understand the reason for the test, others trusted their physician and did not believe it was essential to understand. Some patients were using an online personal health portal system offered through the practice that included information about upcoming tests.
Conclusions Forgetting was the most prominent theme for non-completion of ordered test. Patients felt that providing timely (near desired test completion date) patient reminders, either by phone or by e-mail, would likely improve completion rates of laboratory monitoring for high-risk medications, while providing more information about the test indication would not.
