(Download) "Strategies for Physician Education in Therapeutic Drug Monitoring (Tdm Conference)" by Clinical Chemistry # Book PDF Kindle ePub Free
eBook details
- Title: Strategies for Physician Education in Therapeutic Drug Monitoring (Tdm Conference)
- Author : Clinical Chemistry
- Release Date : January 01, 1998
- Genre: Chemistry,Books,Science & Nature,
- Pages : * pages
- Size : 190 KB
Description
Although therapeutic drug monitoring (TDM) is probably highly beneficial in the aggregate, increasing evidence suggests that current use is suboptimal. In some studies, up to 70-80% of drug quantifications performed in inpatients have been inappropriate, primarily because of routine daily monitoring without pharmacological justification [1, 2]. These data suggest that efforts to improve the use of TDM could result in substantial cost reductions without missing important clinical results. The other side of this coin is that TDM is sometimes omitted when it is indicated. The magnitude of this problem is harder to assess, but the potential consequences in terms of patient harm are greater. Our objective is to discuss strategies for physician education regarding optimal use of TDM. Traditional education approaches, e.g., lectures, can improve practice, but such approaches are labor-intensive and their effects wane with time. Development of formal TDM services with one-on-one education is also labor-intensive, but the effect does not diminish if the service can be maintained. Multidisciplinary quality-improvement projects and the development of critical pathways and guidelines offer additional opportunities for education and for obtaining clinician buyin. Making guidelines evidence-based is likely to promote acceptance from physicians [3]. Computerized provider order entry, in which providers write orders directly on-line, offers the opportunity for decision support, including reminders and feedback at the time of order writing. For example, for a TDM order, the patient's last drug value and guidelines for ordering the next measurement can be displayed. The computer can also help with the issue of underuse by suggesting an order, e.g., after a specific interval or when a new medication is ordered. Computerized suggestions may not be sufficient, however, if physicians are not convinced that the recommended approach is optimal; in these instances, supplemental educational sessions may be required to change behavior. Here, we will discuss our experiences with and the potential of these initiatives for favorably altering physician behavior.
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