Therapeutic drug monitoring in ambulatory care.

There is a growing emphasis on developing ambulatory care services in an attempt to minimize healthcare costs through preventive medicine and outpatient therapeutic management. This creates an environment that can greatly benefit from a pharmacist-managed ambulatory TDM service. The implementation of a pharmacist-managed TDM service can improve patient care, contain the cost of healthcare, and enhance the education of pharmacy/medical students and physicians. The opportunity exists for further development of clinical pharmacy services to positively influence patient care in the ambulatory care setting. This development, however, may be hindered by inadequate reimbursement for services and lack of documentation to support the beneficial impact of clinical pharmacy services on patient outcome. Methods of documenting clinical pharmacists' interventions and outcome must be developed in order to obtain reimbursement for these services.