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Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
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Related Experiment Video

Updated: Jun 2, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

User-Directed vs Interruptive Real-Time Benefit Tools for Medication Changes in Primary Care.

Ryan M Kane1,2,3,4, Sarah Morton-Oswald5, Yuliya Lokhnygina5

  • 1Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

JAMA Network Open
|June 1, 2026
PubMed
Summary
This summary is machine-generated.

Redesigning real-time benefit tools (RTBTs) in electronic health records from user-directed to interruptive significantly increased their display rates. Clinician medication order changes remained similar, indicating sustained attention to RTBT information.

Related Experiment Videos

Last Updated: Jun 2, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Area of Science:

  • Health Informatics
  • Clinical Pharmacy
  • Health Services Research

Background:

  • Real-time benefit tools (RTBTs) integrated into electronic health records (EHRs) offer medication cost estimates and identify cheaper alternatives.
  • While RTBTs improve adherence and reduce costs for chronic disease patients, clinician utilization remains low.

Purpose of the Study:

  • To evaluate the impact of redesigning an RTBT from a user-directed to an interruptive display on its display rate and medication order change frequency.
  • To assess clinician engagement with RTBTs following a design change aimed at increasing visibility.

Main Methods:

  • A retrospective cohort study analyzed EHR data from Duke Health (January 2022 - December 2023).
  • The study compared a user-directed RTBT period (2022) with an interruptive RTBT period (2023) in adult primary care patients with multimorbidity.
  • Generalized linear models were used to adjust for patient and clinician factors, analyzing RTBT display and medication order change frequencies.

Main Results:

  • The interruptive RTBT design was associated with a significant increase in display frequency (RR, 9.62) and medication order changes (RR, 8.37) compared to the user-directed design.
  • RTBT display increased from 1.3% to 13.5% of encounters after the redesign.
  • However, in encounters where the RTBT was displayed, the frequency of medication order changes did not significantly differ between the two designs (RR, 0.93).

Conclusions:

  • Transitioning RTBTs to an interruptive design in EHRs effectively increases their display rates.
  • The sustained rate of medication order changes suggests that clinicians maintained attention and responded to RTBT information regardless of the design change.
  • This highlights the potential of interruptive designs to enhance the utility of RTBTs in clinical practice.