Quantifying the Clinical Significance of Drug—Drug Interactions: Scaling Pharmacists' Perceptions of a Common Interaction Classification Scheme

Abstract

Inconsistencies between published clinical significance scales and the professional judgments of practitioners could affect patient care to the degree that a summary measure of clinical significance affects a practitioner's response to a potential drug-drug interaction. The clinical significance scale developed in this study has good measurement characteristics and reflects the professional judgments of practicing pharmacists. Use of the new scale is recommended on these grounds, although further assessment of its generality is warranted.

A Pharmacoepidemiologic Study of Drug Interactions in a Brazilian Teaching Hospital

“…They depend on patientrelated factors that usually require individual assessment. 16 However, our results showed that some patients had suffered adverse reactions from 'major' DDI.…”

Assessing the clinical significance of drug interactions with fluorouracil in patients with colorectal cancer

“…A limitation of the classification scheme used in this study is that inconsistencies may exist between the significance rating and the professional judgment of practitioners in clinical practice. 58,59 Therefore, the sensitivity of this or any scale should be properly validated. The agreement among panel members regarding the classification of interactions, as reflected by the weighted κ statistics, suggested low interindividual variation.…”

Current Status of Prospective Drug Utilization Review

“…The authors speculated that this inconsistent view may influence the behavior of pharmacists in their reaction or lack thereof to pDUR alerts. 18 Another concern regarding pDUR criteria is the lack of consistency in the adoption of criteria obtained from vendors. A study published in 1992 compared 55 digoxin DDI criteria from 7 vendors used in 16 state Medicaid programs.…”

“…In many instances, the pharmacist never sees or heeds the alert for a variety of reasons. [18][19][20][21] Safe and effective pharmacotherapy occurs in the context of a medication use system with predictable results. 30 The hallmarks of such a system include a high degree of coordination and cooperation among the persons involved: patient, caregiver, prescriber, pharmacist, and nurse.…”

“…Strengthening the scientific base for DUR criteria could reduce variation in pharmacotherapy and contribute to greater confidence that DUR criteria focus on significant, preventable problems. 17 Adequacy of clinical significance rating scales for drug interactions was the subject of research by Roberts et al in 1996. A panel of 63 practicing pharmacists judged the severity and documentation dimensions used to characterize potential drug interactions used by one reference (Drug Interaction Facts).…”