Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Aug 30, 2019
Date Accepted: Mar 25, 2020
Development and Performance of a Web-Based Application to Adjust Urine Toxicology Testing Frequency
ABSTRACT
Background:
Guidelines recommend regular urine drug testing (UDT) in patients on chronic opioid therapy (COT) to improve compliance. Guidelines also recommend more frequent testing in patients at high risk of opioid misuse, but there is no consensus on how to identify high-risk patients and on the absolute testing frequency. Using previously described clinical risk factors of opioid misuse, we developed a web-based tool to adjust UDT frequency in patients on COT.
Objective:
To evaluate a risk stratification tool to adjust UDT frequency in patients on COT.
Methods:
Patients were stratified using an algorithm based on readily available clinical risk factors into categories of presumed low, moderate, high, and high+ risk. The algorithm was integrated in a website to facilitate adoption across practice sites. To test the performance of this algorithm we performed a retrospective analysis in patients on COT. The primary outcome was compliance with the prescribed COT, defined by UDT results consistent with the prescribed COT.
Results:
1056 urine drug tests were performed in 320 included patients. An inconsistent UDT result was registered in 52 patients (16%). The incidence of inconsistent UDT differed across the risk tool categories from 4% (low risk), to 18% (moderate risk), to 18% (high risk), to 23% (high+ risk), respectively. Regression revealed that the moderate (OR: 3.8, 95%-CI: 1.3–11.4, P=0.02), high risk (OR: 3.4, 95%-CI: 1.1–10.5, P=0.04), and high-risk+ (OR: 4.4, 95%-CI: 1.2–16.4, P=0.03) category were associated with an increased risk of having more inconsistent UDT results vs. the low-risk category.
Conclusions:
The tool appears to correctly stratify patients on COT at higher risk of presenting with UDT results inconsistent with the prescribed therapy.
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