Changes in effectiveness of psychotherapeutic drug level monitoring program after lessening pharmacy involvement

The psychotherapeutic drug monitoring policy established by the medical, laboratory, and psychopharmacy departments at Austin State Hospital allowed for psychopharmacists to schedule, interpret, and monitor antidepressant and antipsychotic plasma concentrations. A recent policy change eliminated the psychopharmacists' role in scheduling blood draws for plasma drug concentration determinations. A comparison of the use of psychotropic plasma drug concentrations before and after implementation of the policy change, with regards to appropriate disease states, indication, scheduling, and choice of drug was conducted. Despite a fourfold increase in the number of plasma drug concentrations obtained after the policy change, the physicians appeared to be aware of the steady state requirements and situations in which monitoring plasma drug concentrations was justified. The number of plasma drug concentrations that were obtained to verify a suspected drug interaction, or adverse effect, increased after the new policy was implemented. This seemingly indicates physician uncertainty in determining the clinical implication of potential drug-drug interactions and recognizing which adverse effects may be dose related.