TDM 약동학 자문에 대한 처방의사의 수용여부 평가

Analysis of Prescriber‘s Responses on Clinical Pharmacokinetic Consultation of Therapeutic Drug Monitoring

Background : We evaluated the physician's response on clinical pharmacokinetic consultation including dose readjustment predicted from therapeutic drug monitoring(TDM). This study was also designed to examine factors influencing on the acceptance of clinical pharmacokinetic consultation. Methods : Medical records of two hundred in-patients(119 male and 81 female) were carefully reviewed for the acceptance of dose readjustment consultation of TDM unit in Pusan Paik Hospital. The acceptance was defined as a compliance on the dose readjustment recommended by TDM unit. Data were analysed for the relative factors with acceptance rate on clinical pharmacokinetic consultation using Chi-square test. Results : Among the 474 consultations for 200 patients, the overall acceptance rate was estimated to 74.5%. Factors influencing the acceptance were as follows : changes of dose regimen, the observed drug level in relation to therapeutic range, the age of charge doctor. Follow up TDM was requested in 58.8% of consultations and that rate was significantly higher in the cases of toxic and subtherapeutic level than normal level. In the follow up TDM, only 39.2% of drug level were found to be within normal range when the recommended dose regimen was not accepted by prescribers. However, 79.9% were within normal range in following TDM when prescriber accepted dose regimen recommended by TDM unit. Conclusions : The acceptance of clinical pharmacokinetic consultation seems to be effective to find optimum dose regimen of reaching to target concentration. The education of TDM for physician in charge and the relationship between clinical pharmacokinetists and prescribing doctors contribute to improve the response rate for TDM consultation.