BMJ  2005;330:644-648 (19 March), doi:10.1136/bmj.330.7492.644

Clinical review

Monitoring in chronic disease: a rational approach

¹ University of Oxford, Department of Primary Health Care, Oxford OX3 7LF UK, ² Screening and Test Evaluation Program, School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia

The first 150 words of the full text of this article appear below.

Introduction

"Know which abnormality you are going to follow during treatment. Pick something you can measure." Meador C. A Little Book of Doctors' Rules. Lyons: IARC Press, 1999.

The ritual of routine visits for most chronic diseases usually includes monitoring to check on the progress or regress of the disease and the development of complications. Such checks require that we choose what to monitor, when to monitor, and how to adjust treatment. Poor choices in each can lead to poor control, poor use of time, and dangerous adjustments to treatment. For example, an audit of serum digoxin monitoring in a UK teaching hospital more than 20 years ago showed that the logic behind more than 80% of the tests requested could not be established, the timing of tests reflected poor understanding of the clinical pharmacokinetics, and about one result in four was followed by an inappropriate clinical decision.¹ Improvements are . . . [Full text of this article]

Should we monitor at all?

The phases of monitoring

Pretreatment monitoring
Initial titration: response, control, and safety
Monitoring during treatment
Adjustment to re-establish control
Cessation of treatment

Monitoring strategy

Which measurement?
Choosing the monitoring interval
Who should monitor?

Discussion

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