Effect of an Educational Outreach Program on Prescribing Potential Drug-Drug Interactions

Malone, Daniel C.; Liberman, Joshua N.; Sun, Diana

doi:10.18553/jmcp.2013.19.7.549

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…Despite enhanced medication appropriateness and the intervention with medication review and DDI check, mean number of severe DDIs increased. Previous studies found similar results [53, 54]. This may be related to multi-morbidity and polypharmacy which are associated with an elevated risk of DDIs [52, 55].…”

Section: Discussionsupporting

confidence: 73%

Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT

et al. 2019

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Background Uncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents. Methods The single-arm interventional study (2014–2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes. The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform. The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, number of drugs, number of severe drug-drug interactions and appropriateness of analgesics. Outcomes were measured before, during and after the intervention. Data were analyzed using descriptive and inference-statistical methods. Results Fourteen general practitioners, 11 pharmacists, 9 nursing homes and 120 residents (n = 83 at all testing times) participated. Overall MAI sum-score decreased significantly over time (mean reduction: -7.1, CI95% -11.4 – − 2.8; median = − 3.0; dCohen = 0.39), especially in cases with baseline sum-score ≥ 24 points (mean reduction: -17.4, CI95% -27.6 – − 7.2; median = − 15.0; dCohen = 0.86). MAI sum-score of analgesics also decreased (dCohen = 0.45). Mean number of severe drug-drug interactions rose slightly over time (dCohen = 0.17). The proportion of residents showing agitated behavior diminished from 83.9 to 67.8%. Remaining secondary outcomes were without substantial change. Conclusion Medication appropriateness increased particularly in residents with high baseline MAI sum-scores. Cognitive decline of participating residents was seemingly decelerated when compared with epidemiologic studies. A controlled trial is required to confirm these effects. Interprofessional interaction was structured and performance of medication reviews was facilitated as the online communication platform provided unlimited and consistent access to all relevant and updated information. Trial registration DRKS Data Management, ID: DRKS00007900, date of registration: 2015-09-02 (retrospectively registered i.e. 6 weeks after commencement of the first data collection).

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Section: Discussionsupporting

confidence: 73%

Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT

et al. 2019

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“…Demonstrating the effectiveness of interventions to improve the appropriate use of polypharmacy in older patients is hardly achievable in clinical practice, especially when performing educational meetings/workshops, which can have small or even unproven benefit . In fact, the latest Cochrane review concluded that ‘ It is unclear whether interventions to improve appropriate polypharmacy , such as pharmaceutical care , resulted in clinically significant improvement ’ .…”

Section: Discussionmentioning

confidence: 99%

“…In the recent past, administrative databases have been largely used to estimate the prevalence of DDIs as well as to determine possible predictors/determinants of DDI occurrence, especially in elderly under poly‐therapy . However, only a limited number of studies have attempted to assess the impact of educational campaigns to improve appropriateness of clinicians' prescriptions, with a non‐significant effect of educational outreach programmes on the prescribing rate of potential DDIs .…”

Section: Introductionmentioning

confidence: 99%

Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Raschi¹,

Piccinni²,

Signoretta

et al. 2015

Brit J Clinical Pharma

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Aims The aim was to assess the impact of a campaign for general practitioners (GPs) to reduce clinically‐important drug–drug interactions (DDIs) in poly‐treated elderly patients. Methods We compiled a list of 53 DDIs and analyzed reimbursed prescriptions dispensed to poly‐treated (≥four drugs) elderly (>65 years) patients in the Emilia Romagna region during January 2011–June 2011 (first pre‐intervention period), January 2012–June 2012 (second pre‐intervention period) and January 2013–June 2013 (post‐intervention period). Educational initiatives to GPs were completed in July 2012–December 2012. Pre‐test/post‐test analysis (2013 vs. 2012) was performed, also using predicted 2013 data (P < 0.01 for statistical significance). Results Despite the slight increase in poly‐therapy rate (16% in 2013, +1.5% from 2011), we found a stable or slightly declining number of potential DDIs for each elderly poly‐treated patient (~1.5). In 2013, 11 DDIs exceeded 5% of prevalence rate: antidiabetics‐β‐adrenoceptor blockers ranked first (20.3%), followed by ACE Inhibitors (ACEIs)/sartans‐non steroidal anti‐inflammatory drugs (NSAIDs) (16.4%), diuretics‐NSAIDs (13.6%), selective serotonin re‐uptake inhibitors (SSRIs)‐NSAIDs/acetyl salicylic acid (ASA) (12.7%) and corticosteroids‐NSAIDs/ASA (9.7%). A remarkable reduction emerged for NSAID‐related DDIs (diuretics‐NSAIDs peaked −14.5%; P < 0.01), whereas prevalence of antidiabetics‐β‐adrenoceptor blockers increased (+7.9%; P < 0.01). When using predicted values, the statistical significance disappeared for antidiabetics‐β‐adrenoceptor blockers (+1.3%; P = 0.04), whereas it persisted for almost all NSAIDs‐related DDIs: ACEIs/sartans‐NSAIDs (−3.0%), diuretics‐NSAIDs (−6.0%), SSRIs‐NSAIDs/ASA (−5.9%). Conclusions This campaign contained the burden of DDIs in poly‐treated elderly patients by 1) reducing most prevalent DDIs, especially NSAIDs‐related DDIs and 2) balancing the observed rise in poly‐therapy rate with stable rate in overall prescriptions of potentially interacting drugs per patient.

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“…In addition, evidence regarding treatment efficacy and DDIs is evolving on a daily basis, and therefore, updated resources/information must be available. As a result, the issue of improving prescribing practices is a major focus of many national initiatives, not only to enhance the quality of healthcare services, but also to reduce medication errors and medical care costs [15].…”

Section: Discussionmentioning

confidence: 99%

Physicians’ knowledge of potential covid-19 drug–drug interactions: An online survey in turkey

Sürmelioğlu

Yalçın

Kuşçu

et al. 2020

Postgraduate Medicine

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Objectives: Given the many medications used to treat novel coronavirus disease and its comorbidities and complications, the risk of drug-drug interactions (DDIs) and resulting patient harm is concerning. This study aimed to shed light on physicians' knowledge of potential DDIs related to COVID-19 treatment, to determine the effect of an information brief about these DDIs on their correct response rates, and to identify factors associated with higher levels of knowledge about these DDIs. Methods: The knowledge of physicians regarding the clinical significance and intervention of 7 common potential DDIs during COVID-19 treatment was evaluated via an online survey. Using a pretest-posttest design, the physicians completed a multiple-choice questionnaire first using their existing knowledge, then received an information brief about the DDIs and completed the same questionnaire again. Pretest and posttest scores were evaluated and factors affecting correct response rates were determined using correlation, regression, and post-hoc analyzes. Results: A total of 244 physicians participated in the survey, 147 (60.2%) of whom were involved in the treatment of COVID-19 patients. After the information brief, there were significant increases in the number of correct responses for both clinical significance and interventions (p < 0.0001). In comparisons of pretest knowledge, physicians involved in the treatment of COVID-19 patients showed significantly higher correct response rate for interventions compared to physicians who had not treated COVID-19 patients (p = 0.003). Post-hoc analysis to compare pretest correct intervention responses among all medical specialties revealed significant differences between infectious diseases and family practice (mean difference: 1.059; p = 0.005) and between internal medicine and family practice (mean difference: 1.771; p < 0.0001). Conclusion:Physicians involved in the treatment of COVID-19 patients had more knowledge regarding clinical significance and appropriate management of potential DDIs than those not involved. Therefore, it may be beneficial to organize trainings and issue guidelines about potential DDIs for physicians during the COVID-19 pandemic.

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Effect of an Educational Outreach Program on Prescribing Potential Drug-Drug Interactions

Cited by 9 publications

References 31 publications

Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT

Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT

Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Physicians’ knowledge of potential covid-19 drug–drug interactions: An online survey in turkey

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