Vignette 1 (Undiagnosed Health Condition): In reviewing the EHRs of potentially eligible patients, the researchers notice that one patient has an abnormal laboratory test result that suggests he or she might have diabetes. However, there are no diagnostic codes or medications for diabetes in the chart, so the researchers are concerned that the patient might actually have diabetes and not know it. Vignette 2 (Contraindicated Medications): Now imagine the researchers are reviewing a different patient’s EHR. This person was identified as potentially eligible because of high blood sugar levels, but has no diagnostic codes or medications for diabetes. Upon further inspection, the researchers see that the patient is taking a drug for epilepsy that can raise blood sugar levels. However, the researchers also notice the patient is taking another drug that is not supposed to be taken together with the epilepsy drug. When the two are taken together, it can cause serious side effects. Vignette 3 (Future Health Risk): The researchers are still reviewing EHRs to find potential participants for the diabetes telephone study. During the review, they come across a patient who has lab results showing blood sugar levels that are higher than normal. Unlike the patient in our last example, this patient is not taking any medications that would explain the high blood sugar levels. Although the patient’s levels are not high enough to be classified as diabetes, the researchers are concerned because the patient has other risk factors for becoming diabetic: the patient is older, overweight, and has high blood pressure. Each of these increases the chance that a person might become diabetic. Based on the medical record, the patient has not had a recent test for diabetes and is not taking any medications to reduce the risk of developing diabetes. So nothing is specifically wrong with the patient right now, but it looks like the patient is at high risk for developing diabetes in the future — and there are things that could be done to help the patient reduce that risk. |
