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[Clinical pharmacology in practice]

N Vogt¹, P Dayer

¹Division de pharmacologie clinique, Hôpital cantonal universitaire de Genève.

Schweizerische Medizinische Wochenschrift

|November 19, 1994

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Clinical pharmacology consult services are variably utilized by clinicians, with differing focus between spontaneous requests and postgraduate teaching needs. This impacts real-world prescription practices, especially for elderly patients with renal impairment.

Area of Science:

Clinical Pharmacology
Internal Medicine
Drug Safety

Background:

Clinical pharmacology consult services play a crucial role in optimizing drug therapy.
Understanding clinician needs and the impact of pharmacology education is essential for effective service delivery.
The complexity of modern therapeutics necessitates expert guidance in drug selection and management.

Purpose of the Study:

To evaluate the spontaneous utilization of a university-hospital clinical pharmacology consult service.
To assess the alignment between clinical pharmacology teaching topics and clinician information needs.
To analyze the prescription profiles of internal medicine trainees, focusing on drug management in complex patient populations.

Main Methods:

A 14-month evaluation of a clinical pharmacology consult service at a university hospital.

Related Experiment Videos

Analysis of 663 consult requests, categorized by topic (adverse events, pharmacokinetics, indications, identification).

Review of postgraduate teaching content and prescription data from internal medicine trainees, including patient demographics and renal function.

Main Results:

Spontaneous consults primarily addressed adverse events (53%) and pharmacokinetics (20%), differing from teaching topics (pharmacokinetics 42%, indications 39%).
Prescription analysis revealed 201 patients, mostly elderly, with 40% having impaired renal clearance; only 14% were identified as renally compromised.
Despite 63% of renally compromised patients requiring dosage adjustments, only 44% received them; drug interactions occurred in 9% of treatments.

Conclusions:

Clinician reliance on clinical pharmacology expertise is variable, with a disconnect between spontaneous consults and teaching priorities.
There is a significant gap in identifying and managing drug therapy in renally impaired patients, highlighting a need for improved clinical practice.
The study underscores the importance of clinical pharmacology services in navigating complex therapeutics and improving patient safety, despite variable utilization.