Computerized reminders to monitor liver function to improve the use of etretinate

Objective: to determine whether computerized reminders during the process o f prescribing can improve the use of drugs requiring prior laboratory testi ng according to the indications listed in the Drug Package Insert. Measures : Change in proportion of appropriate prescribing and frequency of severe h epatotoxicity between pre- and post-intervention. Methods: etretinate, a me dication indicated for psoriasis, was selected as a monitored drug because it was the most prescribed of all the identified drugs that require specifi c prior laboratory tests. Computerized reminders are designed to alert a ph ysician who is about to prescribe etretinate either without the alanine ami notranceferase (ALT) test or the aspartate aminotransferase (AST) test with in 3 months or despite abnormality in ALT or AST. Data on alerts were gathe red by using electronic mail whenever alerts occurred. Results: prescriptio ns of etretinate with normal ALT or AST results within the previous three m onths increased suddenly from 25.9% (127/491) in the pre-intervention perio d to 66.2% (353/533) in the post-intervention period (P < 0.0001). Moreover , three patients who used etretinate had markedly abnormal tests in the pre -intervention period, but none of the patients were classified in this way in the post-intervention period. Conclusions: the computerized reminders ap pear to improve physicians' use of a drug requiring specific prior laborato ry tests. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.