A cross-sectional study of the current situation with therapeutic drug monitoring in Thailand: Requirements, challenges and the role of educational institutions

Abstract

Background: Therapeutic drug monitoring (TDM) is a drug dose determination tool for individualised therapy. Objective: This study examined the TDM services provided by hospitals and topics taught in pharmacy schools in Thailand. Methods: TDM service and curriculum questionnaires were sent to 179 hospitals and all 19 pharmacy schools in Thailand. Correlations were tested using Fisher’s exact test. Results: Completed questionnaires were returned by 116 hospitals (64.8%). Forty-three hospitals (37.1%) conducted TDM and most were large hospitals (>500 beds, n=27, 62.8%). Higher numbers of beds and pharmacists positively correlated with conducting TDM (p < 0.001 and p = 0.003, respectively). Phenytoin was the most frequently monitored drug (n=39, 90.7%). All pharmacy schools taught TDM for phenytoin, valproic acid, vancomycin, carbamazepine, and digoxin. The most frequently cited benefit of TDM was to prevent adverse drug reactions (n = 108, 93.1%). The primary reason cited for not conducting TDM was a lack of in-house laboratories (n=78, 67.2%). Conclusion: Despite a positive attitude among respondents and that TDM subjects were being taught in all pharmacy schools in Thailand, less than half of the surveyed hospitals reported conducting TDM. Providing smaller hospitals with access to the TDM laboratories and expertise at large hospitals could increase this proportion.