New App Helps Interpret Urine Drug Test Results
An interview with Jeffrey Fudin, PharmD, DAAPM, FCCP, FASHP
Interpreting urine drug test (UDT) results is difficult, especially considering how frequently false-positive and false-negative results occur. Surrounded by a backdrop of contention among the courts and third-party payers for what constitutes “medically necessary” in-office testing, required frequency, and confirmation by more expensive definitive lab analysis, providers are at a loss as to how to adhere to standards, which remain undefined. While legal court battles continue against various laboratory companies for encouraging precise testing by chromatography, perhaps software apps can help discern when more comprehensive testing is in fact medically indicated.
Practical Pain Management talked with Jeffrey Fudin, PharmD, DAAPM, FCCP, FASHP, developer of a new app called Urintel that helps clinicians better analyze UDT results and make clinical decisions when they find unexpected results.
Q: What is the Urintel application, and how is it designed to help pain practitioners?
Dr. Fudin: Urintel is a software application that was created to help pain practitioners and other health care providers interpret UDT results from an immunoassay test performed at the point of care or a laboratory. One of the key reasons we developed this app is because immunoassay is a qualitative test that lacks specificity for any unique drug; therefore, false-positive or false-negative results are common, and patients may be falsely accused of drug abuse/misuse when they haven’t done anything wrong.
There are no standards to help practitioners interpret the results of UDTs by immunoassay, or to ascertain when false-positive or false-negative results could or should happen. In addition, providers are not trained to interpret immunoassays considering specific drug doses, medicinal chemistry, drug, chemical, and food interactions.
Urintel guides practitioners toward appropriate actions to take when faced with an unexpected result that yields illicit substances or false-positive or false-negative results and suggests when it is appropriate to quantify results using definitive gas or liquid chromatography mass spectrometry. The app is available for use on office computers as well as the Apple iPhone and Android-based phones (eg, Motorola’s Droid, HTC, and Samsung).
Q: How does this application fit into daily practice?
Dr. Fudin: The thought is that when a provider receives UDT results, either the provider or a staff member could enter the information into the Urintel software application. The computer app is intuitive and has 3 steps:
- Enter all medications and doses prescribed to the patient using drop down menus (Figure 1)
- Select results from a UDT (Figure 2)
- The app analyzes the results and presents recommendations that can be saved/printed as a PDF or copied to clipboard for quick “paste” into the electronic health record (EHR) (Figure 3, page 86)
The printed report can be handed to the patient upon triage or when the patient enters the examination room, allowing the information to be communicated in a nonconfrontational way. The patient will see the results as well as the list of potential medications that can cause a false-positive or false-negative result. The health care provider then can educate the patient about what the test results mean.
Q: Is Urintel compatible with EHRs?
Dr. Fudin: A huge benefit is that the software platform for in-office use allows for a printable report that can be copied and pasted into an EHR, saved as a PDF, and attached to the EHR, or faxed to a third-party payer to document the need for definitive testing by chromatography.
Q: How does this app help secure approvals and payment for definitive testing by chromatography from third-party payers?
Dr. Fudin: Doctors are having more and more difficulty getting third-party payers to pay for definitive testing by chromatography. This report offers detailed explanations that justify the need for definitive testing by quantitative confirmation, and the printed report can be faxed immediately to a third-party payer.
I recently received an email from a provider who had a very difficult time having confirmatory testing by chromatography approved by a certain insurance provider under which several of his patients were covered. The insurance company never approved the physician’s request for further confirmatory testing. With a recent patient, the provider used Urintel to analyze the UDT results, faxed the report to the insurance company, and received approval without question.
Q: What are examples of cases in which the Urintel app would be helpful in explaining false-positive results on UDT?
Dr. Fudin: I receive emails all the time from patients begging me to help them because they’ve received a letter from their doctor stating that they are being discharged from clinic because their UDT was positive for cannabinoids, when in fact the positive result was due to their taking the proton-pump inhibitor omeprazole (Prilosec, others).
Last week, a woman told me about her 81-year-old mother who was discharged from her physician’s care because her UDT was positive for amphetamines, cannabinoids, and phencyclidine (PCP). The woman was taking omeprazole (which would give a false-positive for cannabinoids), the antidepressant venlafaxine (Effexor, others), which would give a false positive for PCP, and the anti-Parkinson combination carbidopa/levodopa (Sinemet, others) (which would give a false positive for amphetamines). She received a discharge letter without any confirmation testing being conducted. This happens all the time. So, Urintel is beneficial and educational for providers and patients. Patients can use the smartphone app to open a dialogue with their doctor regarding the legitimacy of their unexpected results and how to interpret them.
From a health care provider’s perspective, the Urintel app would give the provider an opportunity to make a clinical judgment. In the case of the 81-year-old woman, the Urintel report would state that the patient’s positive result for PCP, for example, is not unexpected because the venlafaxine prescribed can cause a false-positive test.
The user also can see a full list of medications that can cause false-positive results for PCP, which helps the clinician ask appropriate open-ended questions about whether the patient is taking any medications of which the clinician is unaware.
Next, the report will recommend “discussing findings with the patient, using clinical judgment, and if indicated, definitive testing by quantitative confirmation.” In this case, the clinician will have a full comprehensive report to add to the patient’s chart justifying their decisions.