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PubMed1997

Telepathologic review: utility, diagnostic accuracy, and interobserver variability on a difficult case consultation service.

The diagnostic accuracy of telepathologic analysis has not been compared to that of conventional light microscopic review on a difficult case consultation service. The anatomic pathology consultation files of the University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepathologic and light microscopic review. The telepathologic and light microscopic crude agreement of five pathologists were compared, with use of the original consultation diagnosis as the "gold standard." Cases were scored as correct, partially correct, or incorrect. After making a video diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope. The pathologists performed significantly better with the light microscope, even after excluding cases in areas of inexpertise (P = .005). The mean percentage of cases that the pathologists wanted to review with the light microscope was 64%, and the major reason for review was diagnostic uncertainty. Cases incorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultation service, pathologists perform significantly better with use of light microscopic than with telepathologic analysis; rarely make an incorrect diagnosis and do not request that case for light microscopic review; and exhibit high telepathologic diagnostic accuracy in areas of expertise.

Adolescent↗
PubMedDate not supplied

Vitamin prescriptions on a hospital general medical ward: result of a drug utilization review.

Records of 103 consecutive admissions to a general medical ward over 4 months in a Veterans Administration Medical Center were reviewed. Assessment was made of nutritional status and potential need for supplemental vitamin therapy based upon predetermined criteria. Thirty-five of the 103 patients received one or more vitamin supplements. No patient received unnecessary vitamins as defined by our criteria. However, 48 patients had indications for vitamin supplementation, but did not receive any. Analysis of data by indication for vitamin therapy revealed 125 indications for vitamin therapy in 83 patients. Of the 125 indications 54 were treated appropriately, but there were no vitamin prescriptions in 71 indicated instances. We conclude that indicated vitamin supplementation may be underutilized in hospitalized general medical patients.

Adult↗
PubMedDate not supplied

Self-prescribed laxative use: a drug-utilization review.

This study was conducted to determine the reasons for the choice of self-prescribed laxatives and to acquire information on how they were used and tolerated. From November 1999 to February 2000, 70 pharmacies, uniformly located throughout the Campania region of southern Italy, distributed a questionnaire to purchasers of over-the-counter laxatives. The average age of the (mostly female) respondents was 45.9 years; 23.8% were elderly. Among the 7324 individuals who completed the survey, 77.6% selected an oral product; 22.4% preferred rectal administration. A physician influenced the choice of a laxative in 37.7% of the cases, a pharmacist in 20.5%; other suggestions came from relatives (14%), acquaintances (12.1%), advertisements (11.7%), and miscellaneous sources (4%). Only 59.8% of respondents used these drugs correctly, and 58.2% consulted a physician or pharmacist because of constipation. Adverse effects, mainly gastrointestinal symptoms, occurred in 6.1% of those surveyed. The long-term use or abuse of laxatives can cause serious medical consequences, as well as mask diseases, delaying diagnosis and appropriate treatment. Physicians, pharmacists, and other health-care personnel should counsel patients on the proper use of these easily available, ubiquitous drugs.

Adolescent↗
PubMed1984

A utilization review of theophylline assays: sampling patterns and use.

Use of the theophylline assay was reviewed for two months in 121 hospital inpatients who received 426 evaluations at a university medical center. Clinicians adapted published audit criteria for the collection and use of theophylline assays. The charts of all patients receiving theophylline were examined daily, and the following data, among others, were collected: pulmonary function tests, arterial blood gases, liver function tests, vital signs, and physician assessments. Only 29.8 percent of the evaluations complied with all criteria. When the audit categories of rational indication, correct performance, and appropriate dosage adjustment were evaluated independently, compliance rates were 69.1, 72.3, and 67.2 percent, respectively. In 171 cases (48.6 percent), the physicians' instructions for the assay were inadequate to ensure proper collection time by the phlebotomist. Hospital laboratory charges for unnecessary, incorrectly performed, or inappropriately used theophylline assays were estimated to exceed +77000 annually. This audit demonstrates the need for a collaborative pharmacokinetics service with reimbursement through the physician billing charge.

Drug Utilization↗
PubMed1990

A drug utilization review of prescribing patterns for trazodone versus amitriptyline.

The second-generation antidepressant trazodone has been thought by some clinicians to exert a less robust antidepressant effect than do tricyclic agents. This impression differs from the findings of numerous published clinical trials. In an effort to determine whether this discrepancy may be due to possible inappropriate dosing or use of trazodone for different patient subtypes, a retrospective chart review of 138 depressed inpatients treated with amitriptyline and of 42 depressed inpatients treated with trazodone was performed to compare their respective prescribing patterns. While these two groups did not differ with regard to most demographic variables, results revealed that patient prescribed trazodone were older (trazodone, mean +/- SD age = 54.5 +/- 8.8 years versus amitriptyline, 43.2 +/- 12.9 years; p less than .001), more often had a recurrent depressive disorder (trazodone = 57.1%, amitriptyline = 39.1%, p less than .06), and more frequently had a history of unresponsiveness to other antidepressants (trazodone = 47.6%, amitriptyline = 11.6%; p less than .001). In addition, initially prescribed daily doses of trazodone were below the recommended starting dose of 150 mg/day (mean +/- SD starting dose = 113.7 +/- 42.1 mg/day), while starting daily doses for amitriptyline (mean +/- SD = 69.8 +/- 20.1 mg/day) were judged to be more adequate relative to the recommended daily dose of 75 mg/day. Final trazodone dosage (mean +/- SD final dose = 217.9 +/- 87.5 mg/day) could be judged to have been far short of optimal levels of 250 to 350 mg/day and of up to 600 mg/day for inpatients and 400 mg/day for outpatient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

A clinical pharmacy-oriented drug surveillance network: results of a nationwide antibiotic utilization review of bacterial pneumonia--1987.

One hundred eighteen pharmacists enrolled in the Drug Surveillance Network completed a survey of antibiotic prescribing patterns for bacterial infections. A total of 319 hospitalized patients being treated for suspected or documented bacterial pneumonia were monitored, and this paper summarizes the data collected on this specific subpopulation. Two hundred three patients (64 percent) were treated for community-acquired pneumonia and 116 patients (36 percent) were treated for nosocomial pneumonia. Seventy-three percent of the nosocomial pneumonias were culture-positive, with a gram-negative microorganism as the predominant isolate. Forty-eight percent of the community-acquired pneumonias were culture-positive with a mixture of gram-positive and gram-negative organisms. Fifty percent of patients were treated with a single agent, 33 percent with two antibiotics, and the remaining 17 percent with a combination of three or more antibiotics. A satisfactory response was noted for 62 and 76 percent of the patients with nosocomial and community-acquired pneumonias, respectively. Twenty percent of the pneumonia patients were switched to oral drug after an average of five days of therapy and discharged from the hospital. Twenty-five adverse events that were possibly or probably related to the antibiotic regimen were reported in 23 of the 350 patients for an overall incidence of 6.5 percent. The results of this survey provide a cross-sectional view of antibiotic prescribing patterns for the treatment of bacterial pneumonia and the outcome of therapy under actual clinical conditions of use.

Adolescent↗
PubMed1987

Utilization review and management of laboratory testing in the ambulatory setting.

Physicians are probably guilty of misusing the clinical laboratory by either ordering too many tests (overutilization) or ordering too few tests (underutilization). This article is concerned mainly with overutilization in terms of searching for asymptomatic disease, too frequent monitoring of tests, ordering of test clusters, and a failure to use available information. The strategies considered to decrease overutilization include educational strategies, audit with feedback, cost-awareness strategies, rationing strategies, financial incentives and risk-sharing strategies, changes in the test request procedures, and administrative mandates of set protocols for laboratory test ordering.

Ambulatory Care↗