Therapeutic drug monitoring beyond 2000

Views, knowledge, and practices of hospital pharmacists about using clinical pharmacokinetics to optimize pharmaceutical care services: a cross-sectional study

Background

Pharmacokinetics (PK) is often used to optimize individualized dosing regimens of some drugs. This study was conducted to determine views, knowledge, and practices of hospital pharmacists in Palestine about using clinical PK to optimize pharmaceutical care services.

Method

This study was conducted in a cross-sectional design using a questionnaire. The questionnaire collected information about the nature of PK courses taught to hospital pharmacists, importance, relevance, effectiveness, adequacy, and depth of these courses, adequacy of PK skills, implementing PK knowledge/skills in current practice, and barriers limiting the implementation of PK to optimize pharmaceutical care services for hospitalized patients. The hospital pharmacists were visited in their places of work and were asked to complete the questionnaire in privacy. Categorical data were compared using Kruskal-Wallis test or Mann-Whitney U tests.

Results

The questionnaire was completed by 145 hospital pharmacists. Of the pharmacists, 84 (57.9%) received basic PK courses, 79 (54.5%) were taught integrated PK courses, and 94 (64.8%) agreed that the PK courses were important to their current practice. Similarly, 85 (57.9%) of the pharmacists were not satisfied with the teaching methods and contents of the PK courses. Pharmacists who obtained their degrees from Palestine were less satisfied with the methods of teaching compared to those who obtained their degrees from foreign countries (p-value = 0.006). Only 25 (17.2%) pharmacists reported frequent use of PK knowledge in their current practice. Lack of practical knowledge and continuing education, poor understanding of PK by pharmacists and other healthcare professionals were identified as barriers limiting the implementation of PK in optimizing pharmaceutical care services to hospitalized patients.

Conclusion

The hospital pharmacists were generally not satisfied with the way PK courses were taught and expressed difficulty in implementing PK knowledge and skills to improve pharmaceutical care services to hospitalized patients. Integrating PK topics within other relevant courses and adopting more clinically oriented learning methods could improve understanding and implementing PK knowledge and skills in optimizing pharmaceutical services to hospitalized patients. Further studies are still needed to determine the optimal teaching/learning methods that can improve knowledge and skill acquisitions of pharmacists in the area of PK.

Clinical pharmacokinetics: perceptions of hospital pharmacists in Qatar about how it was taught and how it is applied

BACKGROUND

The application of clinical pharmacokinetics (PK) is essential when providing pharmaceutical care. Appropriate application of PK monitoring results in improved patient outcomes including decreased mortality, length of treatment, length of hospital stay, and adverse effects of drug therapy. Despite the well-documented evidence of benefits of clinical PK services, many pharmacists find it challenging to apply PK in clinical practice.

OBJECTIVE

To evaluate pharmacists' training backgrounds, attitude, practices, and perceived barriers pertaining to the application of PK in clinical practice in Qatar.

SETTING

All hospitals under Hamad Medical Corporation, the main healthcare provider in Qatar.

METHODOLOGY

This was a cross-sectional, descriptive study that was conducted between October 2012 and January 2013, using a self-administered web-based survey. Pharmacists were eligible to participate if they: (1) were working as full-time hospital pharmacists and; (2) have been in practice for at least 1 year.

MAIN OUTCOME MEASURES

PK contents learned in undergraduate curriculum; perception towards the PK contents and instructions received in the undergraduate curriculum and; application of PK in current clinical practice.

RESULTS

A total of 112 pharmacists responded to the questionnaire. The majority of the respondents (n = 91; 81.3 %) reported that they had received PK course(s) in their undergraduate curriculum. Similarly, the majority (70-80 %) of them agreed that the undergraduate PK courses or contents they received were important and relevant to their current practice. The pharmacists identified spending more time on dispensing and inventory issues rather than clinical practice, scarce resources, and manual rather than computerized PK calculations as some of the barriers they encountered in learning about PK and its application. The characteristics of the surveyed pharmacists such as gender, age, highest academic degree, and country of graduation did not influence the pharmacists' perception and attitudes towards PK teaching and application (p > 0.05).

CONCLUSION

PK course contents were perceived to lack depth and relevance to practice, and pharmacist had no experiential training that included aspects of PK. These, and other issues, result in poor application of PK in practice.

Therapeutic drug monitoring in a developing country: an overview

Therapeutic Drug Monitoring (TDM) was introduced in India in the mid and late 1980s and the last 10 years have seen it grow, together with the growth of separate Clinical Pharmacology departments. The TDM service in the country is broadly of two types: in large teaching hospitals where the service is available through departments of Clinical Pharmacology, and in the private sector, where drug estimations are done by clinical biochemistry departments with minimal interpretation. This article is based on literature review and our own experiences over a 10 year period in a department of Clinical Pharmacology. It focuses on the evolution of TDM, its problems such as lack of funding, special aspects such as the impact of ethnic differences, nutritional deficiencies, quality of medicines and availability of generic products; its utility as a research tool and its future.

Target concentration intervention: beyond Y2K

Target concentration intervention (TCI) is proposed as an alternative conceptual strategy to therapeutic drug monitoring (TDM). It is argued that the idea of a therapeutic range has limited the interpretation of measured drug concentrations and diminished the anticipated clinical benefit to patients by use of an oversimplified pharmacodynamic model. TCI on the other hand embraces pharmacokinetic and pharmacodynamic concepts and uses the idea of a target effect and associated target concentration to make rational individual dose decisions.