[Clinical pharmacology in practice].

A university-hospital clinical pharmacology consult service was evaluated for: spontaneous use by clinicians (reflecting the competence conferred to clinical pharmacologists and the information clinicians seek), subject matters of postgraduate teaching to internal medicine trainees (needs perceived by the clinical pharmacologist), and finally, prescription profile of these trainees (clinical reality). Over 14 months, 663 requests were received (86% for a specific patient). Topics included adverse events (AE) (53%), pharmacokinetics (PK) (20%), treatment indications (T) (19%), and product identification (Id) (8%). In the service holding regular teaching sessions in clinical pharmacology, spontaneously requested consults pertained to: T 49% (mainly pain management, a domain of expertise of this particular clinical pharmacology service), AE 34%, PK 12% and Id 5%. In contrast, teaching covered PK 42%, T 39% (half on pain), and AE 16% of the time. The prescription profile included 201, mostly elderly patients, 40% with an estimated creatinine clearance < or = 50 ml/min. Of the renally compromised patients, only 14% were clearly identified as such by the doctor in charge, although 63% received at least one drug requiring dosage adjustment, which was done in 44% of cases. Interactions were present in 9% of treatments, which were appropriately adjusted in two thirds following routine in-hospital monitoring of low therapeutic index drugs, even though the possibility of an interaction was not explicitly charted. In conclusion, despite increasing complexity of therapeutics, reliance on clinical pharmacologists is variable.(ABSTRACT TRUNCATED AT 250 WORDS)