TY - JOUR
T1 - Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results
AU - Chua, Isaac
AU - Petrides, Athena K.
AU - Schiff, Gordon D.
AU - Ransohoff, Jaime R.
AU - Kantartjis, Michalis
AU - Streid, Jocelyn
AU - Demetriou, Christiana A.
AU - Melanson, Stacy E.F.
N1 - Funding Information:
Dr. Schiff acknowledges support from the Gordon and Betty Moore Foundation and Controlled Risk Insurance Company (CRICO) for the diagnostic error and improvement of the work.
Funding Information:
Dr. Schiff acknowledges support from the Gordon and Betty Moore Foundation and Controlled Risk Insurance Company (CRICO) for the diagnostic error and improvement of the work.
Publisher Copyright:
© 2019, Society of General Internal Medicine.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers’ ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) results, has not been widely studied. Objective: To examine whether providers correctly interpret, document, and communicate LC-MS/MS UDT results. Design: This is a retrospective chart review of 160 UDT results (80 aberrant; 80 non-aberrant) between August 2017 and February 2018 from 5 ambulatory clinics (3 primary care, 1 oncology, 1 pain management). Aberrant results were classified into one or more of the following categories: illicit drug use, simulated compliance, not taking prescribed medication, and taking a medication not prescribed. Accurate result interpretation was defined as concordance between the provider’s documented interpretation and an expert laboratory toxicologist’s interpretation. Outcome measures were concordance between provider and laboratory interpretation of UDT results, documentation of UDT results, results acknowledgement in the electronic health record, communication of results to the patient, and rate of prescription refills. Key Results: Aberrant results were most frequently due to illicit drug use. Overall, only 88 of the 160 (55%) had any documented provider interpretations of which 25/88 (28%) were discordant with the laboratory toxicologist’s interpretation. Thirty-six of the 160 (23%) documented communication of the results to the patient. Communicating results was more likely to be documented if the results were aberrant compared with non-aberrant (33/80 [41%] vs. 3/80 [4%], p < 0.001). In all cases where provider interpretations were discordant with the laboratory interpretation, prescriptions were refilled. Conclusions: Erroneous provider interpretation of UDT results, infrequent documentation of interpretation, lack of communication of results to patients, and prescription refills despite inaccurate interpretations are common. Expert assistance with urine toxicology interpretations may be needed to improve provider accuracy when interpreting toxicology results.
AB - Background: Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers’ ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) results, has not been widely studied. Objective: To examine whether providers correctly interpret, document, and communicate LC-MS/MS UDT results. Design: This is a retrospective chart review of 160 UDT results (80 aberrant; 80 non-aberrant) between August 2017 and February 2018 from 5 ambulatory clinics (3 primary care, 1 oncology, 1 pain management). Aberrant results were classified into one or more of the following categories: illicit drug use, simulated compliance, not taking prescribed medication, and taking a medication not prescribed. Accurate result interpretation was defined as concordance between the provider’s documented interpretation and an expert laboratory toxicologist’s interpretation. Outcome measures were concordance between provider and laboratory interpretation of UDT results, documentation of UDT results, results acknowledgement in the electronic health record, communication of results to the patient, and rate of prescription refills. Key Results: Aberrant results were most frequently due to illicit drug use. Overall, only 88 of the 160 (55%) had any documented provider interpretations of which 25/88 (28%) were discordant with the laboratory toxicologist’s interpretation. Thirty-six of the 160 (23%) documented communication of the results to the patient. Communicating results was more likely to be documented if the results were aberrant compared with non-aberrant (33/80 [41%] vs. 3/80 [4%], p < 0.001). In all cases where provider interpretations were discordant with the laboratory interpretation, prescriptions were refilled. Conclusions: Erroneous provider interpretation of UDT results, infrequent documentation of interpretation, lack of communication of results to patients, and prescription refills despite inaccurate interpretations are common. Expert assistance with urine toxicology interpretations may be needed to improve provider accuracy when interpreting toxicology results.
KW - chronic pain
KW - compliance monitoring
KW - diagnostic error
KW - liquid chromatography-tandem mass spectrometry
KW - oncology
KW - opioid
KW - primary care
KW - substance use disorder
KW - urine drug testing
UR - http://www.scopus.com/inward/record.url?scp=85075172033&partnerID=8YFLogxK
U2 - 10.1007/s11606-019-05514-5
DO - 10.1007/s11606-019-05514-5
M3 - Article
C2 - 31713040
AN - SCOPUS:85075172033
SN - 0884-8734
VL - 35
SP - 283
EP - 290
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 1
ER -