Nature and frequency of drug therapy alerts generated by clinical decision support in community pharmacy

Heringa, Mette; Floor-Schreudering, Annemieke; Tromp, P. Chris; Smet, Peter A. G. M. De; Bouvy, Marcel L.

doi:10.1002/pds.3915

Cited by 25 publications

(32 citation statements)

References 28 publications

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“…Antithrombotics, cardiovascular drugs and non-steroidal anti-inflammatory drugs (NSAIDs) have been described to be the drug classes which are most frequently involved in DDI-related emergency department visits and hospital admissions [ 8 , 15 ]. An analysis in Dutch community pharmacies indicated that the majority of pDDIs appear in a minority of patients and that antithrombotic agents were the drug class which most commonly led to pDDIs [ 16 ]. Still, publications on pDDIs usually investigate general populations [ 3 , 4 , 17 – 23 ], and data focusing on a vulnerable elderly population exposed to high-risk drugs are sparse.…”

Section: Introductionmentioning

confidence: 99%

Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment

et al. 2018

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IntroductionDrug–drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce.MethodsBaseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug–drug interactions (pDDIs) with a clinical decision support system. Data included prescription and self-medication drugs.ResultsThe prevalence of having one or more pDDI was 85.2%. The median number of alerts per patient was three (range 0–17). For 58.4% of the patients, potential severe/contraindicated interactions were detected. Antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) showed the highest number of average pDDI alert involvements per use (2.9 and 2.2, respectively). For NSAIDs, also the highest average number of severe/contraindicated alert involvements per use (1.2) was observed. 91.8% of all pDDI involvements concerned the 25 most frequently used drug classes. 97.5% of the severe/contraindicated pDDIs were attributed to only nine different potential clinical manifestations. The most common management recommendation for severe/contraindicated pDDIs was to intensify monitoring. Number of drugs was the only detected factor significantly associated with increased number of pDDIs (p < 0.001).ConclusionThe findings indicate a high risk for pDDIs in older, polymedicated patients on antithrombotics. As a consequence of patients’ frequently similar drug regimens, the variety of potential clinical manifestations was small. Awareness of these pDDI symptoms and the triggering drugs as well as patients’ self-medication use may contribute to increased patient safety.

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Section: Introductionmentioning

confidence: 99%

Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment

et al. 2018

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“…When pharmacists authorized the software supplier, anonymous data on patient characteristics and dispensed medication (including dispensing date, dose, and dosing regimen) were extracted over the period August 2012 to July 2014. A random sample of 10% of patients per pharmacy to whom at least one drug was dispensed in the period August 2013 to July 2014 was selected . Prescriptions dispensed by multidose drug dispensing systems were excluded from further analysis because no prescription label is used for these prescriptions (special instructions are printed on the bags containing the tablets).…”

Section: Methodsmentioning

confidence: 99%

“…A random sample of 10% of patients per pharmacy to whom at least one drug was dispensed in the period August 2013 to July 2014 was selected. 21 Prescriptions dispensed by multidose drug dispensing systems were excluded from further analysis because no prescription label is used for these prescriptions (special instructions are printed on the bags containing the tablets).…”

Section: Data Collectionmentioning

confidence: 99%

Nature and frequency of dosing instructions on prescription labels in primary care

Borgsteede¹,

Heringa

2019

Pharmacoepidemiology and Drug

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Purpose To investigate the nature and frequency of dosing instructions and auxiliary labels on prescription labels in primary care. Methods A retrospective analysis of data on prescription labels of dispensed drugs extracted from the pharmacy information system of community pharmacies in the Netherlands. Dosing instructions were categorized into four types. Results Data were extracted from 123 community pharmacies. All drugs dispensed for a random sample of 10% of patients were selected. In the sample of 938 479 prescriptions, 96% had a predefined dosing instruction and 2995 different coded instructions were used. Ninety‐five percent of all instructions were covered by 354 coded instructions. Most prescriptions were coded with an instruction indicating once daily use (48.4%) or twice or more times daily use (23.8%) without specification of the time (eg, “1 tablet 1 time a day”). A general instruction (“use as directed”) was given for 7.0% of all prescriptions, and for 6.0%, the instruction was to use “as needed.” For most prescriptions (80.6%), one or more auxiliary labels were generated with the warning “may cause drowsiness” (17.9%) being the most frequent one. Conclusions A limited set of instructions covered the majority of the prescriptions. About a quarter of the prescription labels contained nonspecific dosing instructions for use multiple times a day, and 13.0% were general or “use as needed” instructions. These instructions can potentially be made more comprehensible by rewording and specification of the time of day.

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“…The CBC was based on a fictive case illustrative of DDIs (Fig. 1 ), and plausible for a broad group of respondents: cardiovascular medications are among the most frequently used drugs and they often cause DDIs [ 21 ]. In the first step of the development of the CBC task, realistic attributes and levels were preselected (Table 1 ), representing four common DDI management options that could be applied after consultation between prescriber, pharmacist and patient: (1) no action, use both drugs concurrently; (2) replacement of the medicine the patient is already using; (3) replacement of the newly prescribed medicine; (4) additional monitoring such as blood testing [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

Preferences of Patients and Pharmacists with Regard to the Management of Drug–Drug Interactions: A Choice-Based Conjoint Analysis

et al. 2017

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IntroductionThe management of drug–drug interactions (DDIs) is a complex process in which risk–benefit assessments should be combined with the patient’s perspective.ObjectiveThe aim of this study was to determine patients’ and pharmacists’ preferences regarding DDI management.MethodsWe conducted a choice-based conjoint survey about a fictitious DDI concerning the combination of a cardiovascular drug and an antibiotic for pneumonia. Patients and pharmacists had to choose 12 times between two management options. The options were described by five attributes, including risk, benefit and practical consequences. Each attribute could have two different levels, which were varied over the choice tasks. Latent class analysis was used to identify potential classes of respondents with distinct patterns of similar preferences.Results In total, 298 patients and 178 pharmacists completed the questionnaire. The latent class model for both patients and pharmacists resulted in three classes. For patients, in one class the most importance was attached to avoiding switch of medication (class probability 20%), in a second class to fewer adverse events (41%), and in a third class to blood sampling (39%). For pharmacists, again one class attached the highest importance to avoiding switch of medication (31%). The other classes gave priority to curing pneumonia (31%) and avoiding blood sampling (38%).ConclusionThe results showed diverging preferences regarding DDI management among both patients and pharmacists. Different groups attached different value to risk and benefit versus practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients is a step towards shared decision making in DDI management.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-017-0601-7) contains supplementary material, which is available to authorized users.

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Nature and frequency of drug therapy alerts generated by clinical decision support in community pharmacy

Cited by 25 publications

References 28 publications

Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment

Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment

Nature and frequency of dosing instructions on prescription labels in primary care

Preferences of Patients and Pharmacists with Regard to the Management of Drug–Drug Interactions: A Choice-Based Conjoint Analysis

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