Improving Result Turnaround Time as a Crucial Factor to Increasing Clozapine Therapeutic Drug Monitoring in Hospitalized Patients.

IF 2.9 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of Clinical Psychopharmacology Pub Date : 2025-05-01 Epub Date: 2025-04-02 DOI:10.1097/JCP.0000000000001982

Katelyn N Bye, Megan R Leloux, Kristin C Cole, Matej Markota, Nicholas D Allen, Paul J Jannetto, Jonathan G Leung

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引用次数: 0

Abstract

Purpose/background: Clozapine requires careful monitoring to minimize adverse reactions and optimize response. Because of variable pharmacokinetics and interpatient variability, guidelines recommend therapeutic drug monitoring (TDM), although practical guidance is limited. This study aims to characterize patient factors associated with TDM, rates of TDM use over time, turnaround times of TDM results, and influence of institutional initiatives aimed to improve TDM.

Methods/procedures: A retrospective chart review was conducted at a large 2000-bed academic medical center from August 1, 2015, to November 26, 2023. Adult patients who were administered clozapine during medical or psychiatric inpatient hospitalizations were included. Data collected included patient demographics, clozapine TDM ordering, and clozapine TDM turnaround time. Yearly TDM rates were analyzed to evaluate the impact of various institutional clozapine-related initiatives on TDM practices.

Results: There were 679 encounters involving 334 patients; 62.7 % were men, and 84.4% were White. Younger patients were less likely to have levels drawn (odds ratio 0.98, confidence interval 0.97-0.99), while self-identified Asian patients more likely (odds ratio 7.54, confidence interval 1.60-35.42). TDM rates increased significantly over time for both medical (P = 0.002) and psychiatric (P < 0.001) admission types, with turnaround times improving from 66.07 hours in 2016 to 28.65 hours in 2022. Overall, TDM annual rates increased from 46.2% in 2015 to 69.6% in 2023. The time-period before and after an institutional initiative, which improved TDM turnaround time, was associated with improvements of TDM rates (36.2% vs 67.9%, P < 0.001).

Conclusions: This study highlights an increase in clozapine TDM use during the study period, but use remained suboptimal. Improvement of turnaround time was associated with increased TDM rates.

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改善结果周转时间是提高住院患者氯氮平治疗药物监测的关键因素。

目的/背景：氯氮平需要仔细监测，以减少不良反应和优化反应。由于不同的药代动力学和患者间的可变性，指南推荐治疗性药物监测（TDM），尽管实际指导有限。本研究旨在描述与TDM相关的患者因素、TDM使用率、TDM结果的周转时间，以及旨在改善TDM的机构举措的影响。方法/程序：对2015年8月1日至2023年11月26日某2000张床位的大型学术医疗中心进行回顾性图表分析。包括在内科或精神科住院期间给予氯氮平的成年患者。收集的数据包括患者人口统计数据、氯氮平TDM订单和氯氮平TDM周转时间。分析年度TDM率，以评估各种机构氯氮平相关举措对TDM实践的影响。结果：共就诊679次，患者334例；男性占62.7%，白人占84.4%。年轻患者不太可能绘制水平（优势比0.98，置信区间0.97-0.99），而自我认定的亚洲患者更可能（优势比7.54，置信区间1.60-35.42）。医学（P = 0.002）和精神科（P < 0.001）入院类型的TDM率均随时间显著增加，周转时间从2016年的66.07小时改善到2022年的28.65小时。总体而言，TDM年增长率从2015年的46.2%上升到2023年的69.6%。改善TDM周转时间的制度性举措前后的时间段与TDM率的改善相关（36.2% vs 67.9%, P < 0.001）。结论：本研究强调在研究期间氯氮平TDM的使用有所增加，但使用仍然不理想。周转时间的改善与TDM率的增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychopharmacology 医学-精神病学

CiteScore

4.00

自引率

3.40%

发文量

231

审稿时长

4-8 weeks

期刊介绍： Journal of Clinical Psychopharmacology, a leading publication in psychopharmacology, offers a wide range of articles reporting on clinical trials and studies, side effects, drug interactions, overdose management, pharmacogenetics, pharmacokinetics, and psychiatric effects of non-psychiatric drugs. The journal keeps clinician-scientists and trainees up-to-date on the latest clinical developments in psychopharmacologic agents, presenting the extensive coverage needed to keep up with every development in this fast-growing field.