Physicians’ Knowledge and Attitude Toward Therapeutic Drug Monitoring Practice in Southeastern Bangladesh: A Situation Analysis

Aim: Therapeutic Drug Monitoring (TDM) optimizes drug efficacy and safety, yet its implementation in resource-limited settings like Bangladesh remains poorly characterized. This study aims to assess physicians’ knowledge, attitudes and perceived barriers regarding TDM, alongside current laboratory TDM practices and strategies to enhance its implementation in Chattogram, Bangladesh. Methods: A mixed-methods study was conducted involving 384 physicians from one public and one private tertiary hospital (quantitative survey), supplemented by data from four clinical laboratories and key informant interviews (KIIs) with five physicians (quantitative survey). The survey evaluated participant characteristics, TDM knowledge, attitudes and perceived barriers. KIIs explored professional experiences, laboratory standards, barriers, and improvement strategies for TDM implementation. Results: Nearly half (49.7%) of physicians demonstrated poor TDM knowledge, while 37.8% had moderate knowledge; only 12.5% possessed good knowledge. Despite favorable attitudes (76.0%), clinical adoption was very low (13.3%). Key systemic barriers included: unavailability of TDM tests (93.8%), absence of TDM training (93.5%), insufficient clinical guidelines (90.6%), and poor knowledge (89.3%). Laboratory data identified benzodiazepines as the most assayed drug class (60-180 tests annually/lab). Qualitative findings reinforced these barriers, highlighting inaccessible infrastructure, unreliable laboratories and sociocultural gaps. KIIs emphasized that multisectoral strategies include policy reform, education, quality assurance and priority-based access. Conclusion: Significant knowledge gaps and critically low utilization exist despite physicians’ positive attitudes toward TDM in Chattogram. Implementation is severely hindered by systemic barriers, notably unavailability, inadequate training, and lack of guidelines. Urgent, multifaceted interventions addressing these barriers are essential to improve TDM adoption and patient care in Bangladesh.