がん専門病院における抗MRSA薬TDM血中濃度測定オーダーの医師・薬剤師タスクシェア：後方視的前後比較研究

抄録

In August 2025, we implemented physician-pharmacist task sharing for therapeutic drug monitoring (TDM) of anti-methicillin-resistant Staphylococcus aureus agents. Before implementation, physicians entered initial and follow-up TDM orders after pharmacist feedback, but afterward, pharmacists entered orders (under physician direction) when they identified omissions or errors. In a retrospective before-after study, we compared Pre- (n = 153) and Post-task sharing groups (n = 139) in vancomycin- and teicoplanin-treated cancer patients. Primary outcomes were no physician order for initial or follow-up TDM, and urgent TDM orders. Secondary outcomes were days per TDM measurement, renal/hepatic dysfunction, and estimated monthly total physician time for TDM order entry. For vancomycin, no physician order for initial TDM showed no significant change (44.7％ vs 45.6％, P = 1.00), but significant decreases were seen in no physician order for follow-up TDM (12.3％ vs 1.9％, P = 0.01) and urgent TDM orders (6.3％ vs 0.0％, P < 0.01). Similar initial and follow-up TDM order results were obtained for teicoplanin (35.8％ vs 43.9％, P = 0.29, and 3.9％ vs 0.0％, P = 0.03, respectively). Mean days per TDM measurement decreased significantly for teicoplanin (5.2 vs 4.6, P < 0.01) but not vancomycin (4.2 vs 4.1, P = 0.72). Rates of renal/hepatic dysfunction did not change. The estimated monthly total physician time for TDM order entry significantly decreased after task sharing implementation (median, 334.8 min vs 72.8 min, P = 0.03). The task sharing program was associated with fewer missed follow-up orders and urgent add-on orders and reduced estimated physician workload related to order entry.