Current Status of Therapeutic Drug Monitoring in Australia and New Zealand: A Need for Improved Assay Evaluation, Best Practice Guidelines, and Professional Development

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Title Current Status of Therapeutic Drug Monitoring in Australia and New Zealand: A Need for Improved Assay Evaluation, Best Practice Guidelines, and Professional Development
Author Norris, Ross Leslie Greenland; Martin, Jennifer H.; Thompson, Erin; Ray, John E.; Fullinfaw, Robert O.; Joyce, David; Barras, Michael; Jones, Graham R.; Morris, Raymond G.
Journal Name Therapeutic Drug Monitoring
Year Published 2010
Place of publication United States
Publisher Lippincott Williams & Wilkins
Abstract The measurement of drug concentrations, for clinical purposes, occurs in many diagnostic laboratories throughout Australia and New Zealand. However, the provision of a comprehensive therapeutic drug monitoring (TDM) service requires the additional elements of pre- and postanalytical advice to ensure that concentrations reported are meaningful, interpretable, and clinically applicable to the individual patient. The aim of this project was to assess the status of TDM services in Australia and New Zealand. A range of professions involved in key aspects of TDM was surveyed by questionnaire in late 2007. Information gathered included: the list of drugs assayed; analytical methods used; interpretation services offered; interpretative methods used; and further monitoring advice provided. Fifty-seven responses were received, of which 42% were from hospitals (public and/or private); 11% a hospital (public and/or private) and pathology provider; and 47% a pathology provider only (public and/or private). Results showed that TDM is applied to a large number of different drugs. Poorly performing assay methods were used in some cases, even when published guidelines recommended alternative practices. Although there was a wide array of assays available, the evidence suggested a need for better selection of assay methods. In addition, only limited advice and/or interpretation of results was offered. Of concern, less than 50% of those providing advice on aminoglycoside dosing in adults used pharmacokinetic tools with six of 37 (16.2%) respondents using Bayesian pharmacokinetic tools, the method recommended in the Australian Therapeutic Guidelines: Antibiotic. In conclusion, the survey highlighted deficiencies in the provision of TDM services, in particular assay method selection and both quality and quantity of postanalytical advice. A range of recommendations, some of which may have international implications, are discussed. There is a need to include measures of impact on clinical decision-making when assessing assay methodologies. Best practice guidelines and professional standards of practice in TDM are needed, supported by an active program of professional development to ensure the benefits of TDM are realized. This will require significant partnerships between the various professions involved.
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1097/FTD.0b013e3181ea3e8a
Volume 32
Issue Number 5
Page from 615
Page to 623
ISSN 0163-4356
Date Accessioned 2010-12-21
Date Available 2011-01-27T06:46:21Z
Language en_AU
Faculty Griffith Health Faculty
Subject Pharmacology and Pharmaceutical Sciences
URI http://hdl.handle.net/10072/35838
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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