Impact of decentralized pharmacokinetics consultation service.

The effects of pharmacokinetics consultation by a pharmacist on the quality of drug therapy were studied in a 500-bed teaching hospital. Data were collected retrospectively for three time periods: three months before, four months during, and three months after a period of intervention by a pharmacist with special responsibilities for pharmacokinetic monitoring of patients on a medical team. For the four-month intervention period, data were also collected for a parallel group of patients managed by another medical team that included pharmacy residents and students. Patients were included in the study if they had received either an aminoglycoside or a theophylline preparation. The preintervention, postintervention, and parallel groups were random samples of patients on the study ward, and the intervention group included all patients admitted to the pharmacist intervener's medical team who had received a drug covered by the study. Of serum drug concentration determinations (SDCDs) in the pharmacist intervention phase, 54% were appropriate, compared with 16% before intervention, 21% in the postintervention phase, and 46% in the patients of the other medical team. In the pharmacist intervention group, greater numbers of SDCDs were obtained appropriately and used appropriately in making therapeutic decisions, as evidenced by more subsequent measurements in the therapeutic range. Pharmacist intervention did not affect the number of adverse drug reactions or medical specialty consultations or the average length of stay. Decentralized pharmacokinetics services can have a positive effect on the quality of serum drug concentration determinations, dosage adjustments, and drug therapy.