Clinical Chemistry
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Clinical Chemistry 44: 401-407, 1998;
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(Clinical Chemistry. 1998;44:401-407.)
© 1998 American Association for Clinical Chemistry, Inc.

TDM Conference

Strategies for physician education in therapeutic drug monitoring

David W. Bates1,a, Steven J. Soldin2, Petrie M. Rainey3, and Joseph N. Micelli4

1 Center for Applied Medical Information Systems Research, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston MA.

2 Department of Medicine, National Medical Center, Washington, DC.

3 Department of Laboratory Medicine, School of Medicine, Yale University, New Haven, CT.

4 Pfizer Pharmaceuticals, Atlanta, GA.
a Address correspondence to this author, at: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115. Fax (617)732-7072.


Abstract

Although therapeutic drug monitoring (TDM) is probably very useful overall, studies suggest that it could be used better. Many drug concentrations appear to have inappropriate indications or suboptimal timing, particularly in the inpatient setting. Undermonitoring is also a concern. Thus, it may be possible to both improve the quality of TDM and reduce the overall costs of care. Here we review approaches for improving the use of TDM and present some illustrative experiences. Specific approaches discussed include use of traditional approaches such as lectures and newsletters, multidisciplinary quality improvement efforts, formal TDM services, and use of the computer as a tool for education and behavior change. Computerized methods appear to hold substantial potential, particularly as more organizations develop better information systems, but other approaches are also effective and are complementary. To be most successful, interventions should consider all stages of the process.




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