Morris R G
Department of Clinical Pharmacology, The Queen Elizabeth Hospital, Woodville, South Australia.
Ther Drug Monit. 1998 Dec;20(6):598-601. doi: 10.1097/00007691-199812000-00002.
Therapeutic drug monitoring (TDM) services, like many diagnostic services in public hospitals, have been under scrutiny over recent years as funding has decreased. The Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) sought to review clinical pharmacology departments to consider how the changes that have been implemented have affected the delivery of TDM in recent years. A questionnaire was sent to such departments and all those known to be delivering TDM services responded. The survey demonstrated that of the 11 departments contributing TDM assays, 10 had lost tests and staffing to general biochemistry departments; eight departments had been delivering research and development in TDM. The TDM tests retained in clinical pharmacology were typically the more complex chromatographic or labor-intensive toxicology tests or the more expensive immunoassays. If this direction in Australasia is typical of the situation internationally, it should be a matter of great concern to all those with a particular interest in TDM. Is the future of TDM to be one in which only rapid immunoassays will be provided, and by a staff not fully able to provide pharmacokinetic support and interpretation of such tests (i.e., to become simply number-generating services) despite all the pharmacoeconomic data that is increasingly available?
与公立医院的许多诊断服务一样，近年来，随着资金减少，治疗药物监测（TDM）服务受到了严格审查。澳大利亚临床与实验药理学家和毒理学家协会（ASCEPT）试图对临床药理学部门进行审查，以考虑近年来实施的变革如何影响TDM的提供。一份调查问卷被发送至这些部门，所有已知提供TDM服务的部门都进行了回复。调查显示，在提供TDM检测的11个部门中，有10个部门的检测项目和人员流失到了普通生物化学部门；8个部门一直在开展TDM的研发工作。临床药理学部门保留的TDM检测通常是更复杂的色谱法或劳动强度大的毒理学检测，或者是更昂贵的免疫测定法。如果澳大利亚的这种情况在国际上具有代表性，那么所有对TDM特别感兴趣的人都应该高度关注。TDM的未来是否会是这样一种情况：尽管有越来越多的药物经济学数据，但只提供快速免疫测定法，而且提供这些检测的工作人员无法充分提供药代动力学支持和对检测结果的解读（即仅仅成为数据生成服务）？
