STRATEGIES FOR PHYSICIAN EDUCATION IN THERAPEUTIC DRUG-MONITORING

Although therapeutic drug monitoring (TDM) is probably very useful ove rall, studies suggest that it could be used better. Many drug concentr ations appear to have inappropriate indications or suboptimal timing, particularly in the inpatient setting. Undermonitoring is also a conce rn. Thus, it may be possible to both improve the quality of TDM and re duce the overall costs of care. Here we review approaches for improvin g the use of TDM and present some illustrative experiences. Specific a pproaches discussed include use of traditional approaches such as lect ures and newsletters, multidisciplinary quality improvement efforts, f ormal TDM services, and use of the computer as a tool for education an d behavior change. Computerized methods appear to hold substantial pot ential, 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 t he process.