Evaluation of treatment changes following electronic consultation to a pharmacist-run urine drug testing service in a veterans healthcare system

In 2013, the North Florida/South Georgia Veterans Healthcare System established a pharmacist-run urine drug testing (UDT) electronic consultation (e-consult) service to assist providers with interpretation of this useful yet complex clinical tool. This pilot study aimed to classify clinical treatment changes implemented following e-consult to a pharmacist-run UDT service and analyze factors limiting pharmacist intervention postconsultation. One hundred forty-three e-consults were completed in the 2-year study period including interpretation of 190 UDT results classified as expected, unexpected, or not necessarily inappropriate based on prescription profile at time of urine immunoassay test. Preconsult evaluation revealed that in more than 70 percent of cases, no confirmatory testing was ordered on the sample in question by the requesting provider. Of the 28 percent of UDT results classified as unexpected, 32 percent identified the presence of an illicit substance. Completed e-consults provided either education-based (informative) or actionbased (decisive) recommendations. In 50 percent of the cases where unexpected substances were identified, pharmacy specialists recommended immediate action to be taken by the provider. Subsequent review indicates that timely documentation of postconsultation action by requesting provider was only present in 32 percent of this group. Continued efforts toward an improved understanding of UDT utility by providers, along with expedited placement of e-consult following urine collection, may allow for increased implementation of pharmacist interventions and lead to more optimal use of this clinical tool.