Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital.

Autor:	Wong KR; PGY-2 Psychiatric Pharmacy Residency Program Director, Clinical Pharmacy Specialist, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota,krwong1@uwalumni.com., Nelson LA; Associate Professor, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; Clinical Pharmacist, Center for Behavioral Medicine, Kansas City, Missouri., Elliott ESR; Director of Pharmacy, Center for Behavioral Medicine, Kansas City, Missouri and Northwest Missouri Psychiatric Rehabilitation Center, St Joseph, Missouri., Liu Y; Associate Professor, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri., Sommi RW; Associate Dean, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; Vice Chair, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; Professor of Pharmacy Practice and Psychiatry, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri., Winans EA; Clinical Associate Professor, Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri; Clinical Pharmacist, Truman Medical Center Behavioral Health, Kansas City, Missouri.
Jazyk:	angličtina
Zdroj:	The mental health clinician [Ment Health Clin] 2016 Mar 08; Vol. 6 (1), pp. 1-7. Date of Electronic Publication: 2016 Mar 08 (Print Publication: 2016).
DOI:	10.9740/mhc.2016.01.001
Abstrakt:	Introduction: This study assesses the utilization of antipsychotic therapeutic drug monitoring (TDM) and describes characteristics of appropriate and inappropriate TDM at a state psychiatric hospital. Methods: A retrospective, descriptive review was conducted for antipsychotic TDM completed between December 1, 2009, and June 30, 2011, at a 65-bed adult inpatient extended-care and forensic state psychiatric hospital. Results: One hundred thirty-three (n = 133) antipsychotic serum levels were collected from 44 patients during the study period. Sixty-nine percent (69%) of the TDM were deemed inappropriate, 28% were appropriate, and 3% could not be designated appropriate or inappropriate owing to the lack of information regarding steady-state conditions. The primary reason for inappropriate TDM was lack of documentation with regard to the indication for TDM (n = 79, 59.3%), the intervention following laboratory analysis (n = 88, 66%), or both. Appropriate TDM was associated with a lower laboratory cost for antipsychotic serum level ($48.98 ± $53.49 versus $72.06 ± $51.02, P < .05), lower daily cost of scheduled psychiatric medications ($17.72 ± $23.03 versus $32.26 ± $31.05, P < .05), lower daily cost of total medications ($19.28 ± $24.91 versus $33.82 ± $31.03, P < .05), fewer scheduled psychiatric medications (2.95 ± 1.90 versus 4.04 ± 2.19, P < .01), and fewer total scheduled medications (5.95 ± 3.60 versus 7.60 ± 3.29, P < .05). Inappropriate TDM led to approximately $6,753 in avoidable laboratory costs over a 20-month period. Discussion: Therapeutic drug monitoring is a complex process with many points at which errors may occur. The majority of antipsychotic levels at this state psychiatric hospital were not documented in a way that was clinically useful. Inappropriate TDM was associated with increased laboratory and medication costs. Competing Interests: Disclosures: Authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this publication. This publication was previously presented as a poster at the College for Psychiatric and Neurologic Pharmacists Annual Meeting, Tampa, Florida, April 30, 2012.
Databáze:	MEDLINE
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