How to establish a pharmacokinetics consulting service for ambulatory patients.

Guidelines on establishing a pharmacokinetics consultation service are presented with emphasis on outpatient services. Need for the service must first be demonstrated, using the literature and local data on frequency of serum drug concentration monitoring for particular drugs and patient subgroups. Physician interest in the program must be determined. The pharmacist intervention may be restricted to technical interpretation of serum drug concentration data, or it can include advice based on the patient's disease process, drug effects, and the interaction between the two. In the service described, a patient interview, a chart review, drug analysis, and a written consultation were provided. A flow chart showing movement of the patient through the service was used, and the pharmacist documented the consultation in the patient's medical record, including recommendations for dosage change and follow-up. Cost items to consider in establishing the service include equipment and supplies, space, and personnel. Staff members who are responsible for serum drug analyses must meet state-specific requirements. In estimating revenues, the current number of requests for serum drug concentrations should be doubled and the institution's estimated rate of collection should be used. After the service is established, the cost of a computerized system for pharmacokinetic predictions may be justified by the increased efficiency of such a system.