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Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital

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...

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Autores principales: Wong, Kara R., Nelson, Leigh Anne, Elliott, Ellie S. R., Liu, Yifei, Sommi, Roger W., Winans, Elizabeth A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: College of Psychiatric & Neurologic Pharmacists 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009241/
https://www.ncbi.nlm.nih.gov/pubmed/29955441
http://dx.doi.org/10.9740/mhc.2016.01.001
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author Wong, Kara R.
Nelson, Leigh Anne
Elliott, Ellie S. R.
Liu, Yifei
Sommi, Roger W.
Winans, Elizabeth A.
author_facet Wong, Kara R.
Nelson, Leigh Anne
Elliott, Ellie S. R.
Liu, Yifei
Sommi, Roger W.
Winans, Elizabeth A.
author_sort Wong, Kara R.
collection PubMed
description 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.
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spelling pubmed-60092412018-06-28 Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital Wong, Kara R. Nelson, Leigh Anne Elliott, Ellie S. R. Liu, Yifei Sommi, Roger W. Winans, Elizabeth A. Ment Health Clin Original Research 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. College of Psychiatric & Neurologic Pharmacists 2016-03-08 /pmc/articles/PMC6009241/ /pubmed/29955441 http://dx.doi.org/10.9740/mhc.2016.01.001 Text en © 2016 CPNP. http://creativecommons.org/licenses/by-nc/3.0/ The Mental Health Clinician is a publication of the College of Psychiatric and Neurologic Pharmacists. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Wong, Kara R.
Nelson, Leigh Anne
Elliott, Ellie S. R.
Liu, Yifei
Sommi, Roger W.
Winans, Elizabeth A.
Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title_full Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title_fullStr Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title_full_unstemmed Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title_short Utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
title_sort utilization of antipsychotic therapeutic drug monitoring at a state psychiatric hospital
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009241/
https://www.ncbi.nlm.nih.gov/pubmed/29955441
http://dx.doi.org/10.9740/mhc.2016.01.001
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