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Therapeutic Drug Monitoring and The Patient Adherence Dilemma
Increasing medical practice revenue


Patient adherence within the medical community can mean different things to different providers depending on the specialty. For patients that require therapeutic drug monitoring, adherence to medication can mean the difference between wellness and illness. An estimated 30 to 50 percent of U.S adults are not adherent to long-term medications, so one can only imagine the difficulties that brings for both patients and providers. 

What is therapeutic drug monitoring?


In the simplest of terms, therapeutic drug monitoring (TDM) is a form of testing that tells a provider the concentration of certain medications in a patient’s blood and what bodily systems it may be impacting. TDM is used in a variety of specialties to include, but is not limited to, cardiology, internal medicine, neurology, psychiatry, pulmonology, nephrology, rheumatology, gastroenterology, and many others. 

A patient is first deemed a good candidate for a medication requiring TDM based on several factors such as age, weight, current organ function, current medication regimen, or even results from pharmacogenomic testing. Once the medication is prescribed, a predetermined length of time passes before the patient is required to undergo routine laboratory work to test for current medication concentration along with a clinical assessment to rule out signs or symptoms of side effects. Providers then use their clinical judgment to determine if the medication must be adjusted, which then requires the patient to return again at a predetermined time for ongoing assessments. 

The importance of therapeutic drug monitoring


One may ask themselves: “Why does it even matter? The medication works or it doesn’t.” Certain medications have a narrow therapeutic window which can cause concern for patient wellness if medication is taken outside of that window. Providers use TDM to determine important factors such as non-adherence, subtherapeutic levels, and toxicity. The ability to identify if the patient is adherent to prescribed therapies as well as identifying the need to adjust medications to prevent patient injury is important in the long-term wellness of the patient. 

Studies have shown that patients undergoing TDM and who were adherent to medication protocol experienced fewer adverse effects, improved their ability to meet their own daily needs, and lowered overall medical costs as a result of fewer hospital admissions. 

The problem is that as medical practices grow, the ability to track a patient’s needs during TDM can become convoluted. Providers and medical staff must check when each patient’s labs are completed, document the results, communicate the need for medication changes to the patient, and repeat these steps for every designated time period. What would be the best practice for tracking TDM patients? And communicating with them about their missed appointments or the dangers associated with missing TDM steps such as laboratory work or patient assessments? The ramifications of non-adherence to medications coupled with the endless possibilities of communication errors can result in an increased risk of patient injury or even death. Some long-term effects of unmonitored medications can result in cardiovascular disease, kidney disease, thyroid disease, liver disease, and other chronic or life-threatening conditions. 

An easier way to communicate and track patient needs


At pMD, we are dedicated to making life easier for providers and patients alike by helping decrease communication errors, increase adherence, and improve patient outcomes. For each new customer, pMD takes the needs of the practice to heart and has the ability to build out custom fields for patient populations such as those who may require therapeutic drug monitoring, for example. In addition to this simplified way of keeping track of patient needs, pMD offers HIPAA-compliant communication with patients. While therapeutic drug monitoring may be associated with certain patient populations, pMD is dedicated to helping a variety of different patient populations and specialties.

 
To find out more about pMD's suite of products, which includes our charge capture and MIPS registrybilling servicestelehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.
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