Therapeutic drug monitoring in community pharmacy — a feasibility study

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Abstract
A study was carried out to examine the feasibility of providing a community pharmacy based theophylline therapeutic drug monitoring service for asthma patients. Twenty-two patients attending 12 general practitioners (GPs) participated in the study. Their serum theophylline concentrations were measured and via the use of patient medication records an estimate of compliance with the prescribed dosage regimen was made. If the latter was satisfactory and the serum theophylline concentration was not within the target range of 10–20 μg/ml agreed with GPs, a computer program using Bayesian kinetic principles was used to calculate an appropriate dosage adjustment. This dosage adjustment was made after agreement was obtained from each patient's GP. Patients found to be non-compliant were counselled. Follow-up assessments were carried out after three and nine months; compliance was also assessed at 12 months. Eighteen per cent of patients had serum concentrations within the target range at the beginning of the study; this improved significantly (P<0.05, chi-squared) to 72 per cent and 68 per cent at three and nine months, respectively. Compliance data also improved significantly (P<0.01) over the study period, from a baseline of 59 per cent compliant to a final figure of 86 per cent. Both outcome measures indicate the value of the community pharmacy based monitoring service.

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