Capsule Commentary on Fisher et al., Patient Completion of Laboratory Tests to Monitor Medication Therapy: A Mixed-Methods Study

Medicines are vital for preventing and treating diseases, but have the potential for harm. They can cause unintended effects, or adverse drug reactions (ADRs), many of which are preventable. The incidence of serious ADRs in U.S. hospitals is high and among the leading causes of death. ¹ Many drugs require regular laboratory monitoring; such monitoring can help reduce the risk of ADRs and promote patient safety.

The mixed-methods study by Fischer et al. ² characterizes the frequency of missed monitoring in a single health plan, as well as patient, provider and system factors associated with test non-completion. They found that up to 24 % of ordered tests were not completed; this was more common in younger patients, those taking fewer medications and those having less frequent visits. Reassuringly, nearly all patients understood the reason for the requested tests and were satisfied with the provider’s explanation. The principal reason for missing requested tests was forgetting. The majority of interviewed participants felt a reminder would be helpful; it may be worth investigating whether a text messaging system ³ could help increase test completion for these types of patients.

In this study, providers entered an expected completion date rather than a specific date for laboratory tests. While this flexibility generally works with patients, the lack of a specific appointment may have contributed to patients’ test non-completion. The technology inherent in Electronic Medical Record (EMR) could be harnessed to allow the prescriber the tools to track testing and remind them of patients who have not completed tests. In addition, EMRs, particularly systems that include a patient portal, may be configured to send reminders to patients. Given the finding that most patients didn’t get testing because they forgot, adapting EMRs to send patient reminders may help address this important issue.