Automated therapeutic drug monitoring in an ambulatory care endocrine clinic.
OBJECTIVE
To develop and implement an automated therapeutic drug monitoring system for accessing data from endocrine clinic patients who had been prescribed insulin, oral hypoglycemic agents (OHA), or levothyroxine.


METHODS
We designed a computer system to retrieve clinical data from the Medical Information System (MIS), a centralized hospital computer system, and import this information directly into a Macintosh personal computer. Physician entry of prescriptions for insulin, OHA, or levothyroxine into MIS formed the basis for a computer program to retrieve daily diagnostic and prescription information, demographics, and laboratory analyses, including blood glucose and glycosylated hemoglobin for insulin and OHA orders and free and total thyroxine, total triiodothyronine, and thyroid stimulating hormone for levothyroxine orders. The information was imported into a database program (4th Dimension).


RESULTS
The system identifies laboratory values outside of predetermined therapeutic ranges, maintains an up-to-date patient profile, and edits and generates reports. Preliminary experience suggests that automation eliminates 75-90 percent of the time required to manually collect the same information, and improves the accuracy, comprehensiveness, and utility of reports.


CONCLUSIONS
Automated therapeutic drug monitoring minimizes the time required to collect clinical data, alerts clinicians to potential problems, and provides a means to assess overall therapeutic management. Our methodology can be used to evaluate other medications in a variety of general or specialty clinics.
Foy
J L
JL
Information Systems Department, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
Eastman
R C
RC
Nealon
R C
RC
Bowen
P M
PM
Pengelly
M L
ML
Drass
J A
JA
Dorworth
T E
TE
Pucino
F
F
D000553:Ambulatory Care / Q000592:standards; D016303:Clinical Pharmacy Information Systems; D003628:Database Management Systems; D016903:Drug Monitoring / Q000379:methods*; D011307:Drug Prescriptions; D001330:Electronic Data Processing; D004704:Endocrinology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D009316:National Institutes of Health (U.S.); D010044:Outpatient Clinics, Hospital / Q000592:standards*; D012984:Software; D013974:Thyroxine / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
D007004:Hypoglycemic Agents; D007328:Insulin; D013974:Thyroxine