Recommendations for Generating, Evaluating, and Implementing Drug‐Drug Interaction Evidence

Abstract

In October 2009, a 2-day, multistakeholder, national conference was held in Rockville, Maryland, to discuss and propose methods to improve the drug-drug interaction (DDI) evidence base and its evaluation and integration into clinical decision support (CDS) systems. The conference featured participants representing consumers, health care providers, those responsible for relevant policies and guidelines, and developers and vendors of DDI compendia, databases, and CDS systems. One desired outcome of the conference was to prepare recommendations on critical issues surrounding DDI evidence. A set of recommendations was developed to improve the generation, evaluation, and translation of DDI evidence into CDS systems based on presentations by experts and the supporting literature. These recommendations were reviewed initially by conference moderators, speakers, and Scientific Steering and Planning Committee members, and subsequently by all attendees. The following recommendations were developed to increase patient safety by improving the relevance and assessment of DDI evidence: conduct well-designed studies to determine the incidence, outcomes, and patient-level risk factors for DDIs; use a systematic and transparent process for evaluating the DDI evidence in order to estimate the severity and risks of DDIs; and improve the integration of DDI evidence into electronic CDS. Opportunities exist to improve the DDI evidence base, develop and promote a systematic approach for evaluating the evidence, and integrate this evidence into meaningful CDS.

Drug interaction databases in medical literature: transparency of ownership, funding, classification algorithms, level of documentation, and staff qualifications. A systematic review

“…The above issues reflect the lack of gold standard and consensus that have been called for by several author groups [21,22,41,42]. While implementation of the suggestions made to standardization of evaluation of evidence and clinical consequences may resolve some of the discrepancies the importance of transparency cannot be underestimated [21][22][23]43].…”

“…While implementation of the suggestions made to standardization of evaluation of evidence and clinical consequences may resolve some of the discrepancies the importance of transparency cannot be underestimated [21][22][23]43]. Clinical health-care providers must have readily access to available overview of the algorithms and procedures of decision support systems.…”

“…While discrepancies among drug-drug interaction databases are well documented, no studies have systematically addressed and compared the transparency of ownership, funding, information, classifications, staff training, and underlying documentation among drug interaction databases [12][13][14][15][16][17][18][19][20]. In the light of the discrepancies between drug interaction databases, such information is imperative to users seeking decision support in order to act upon such with confidence [8,21,22].…”

“…classification of DDIs, and emphasized the need for transparency and systematic evaluation methods [21,22]. A US White Paper report on conflicts of interests in drug compendia stressed the importance of transparency with respect to competing interests [23].…”

Determination of Potential Drug–Drug Interactions Using Various Software Programs in a Community Pharmacy Setting

“…19 The following suggestions would improve patient safety: well-designed studies should be conducted to determine the incidence, outcomes, and patient-related risk factors of DDIs; algorithms should be produced for defining systematic and clear processes of assessing evidence to evaluate the risk and severity of possible DDIs; and evidence of possible DDIs should be integrated into electronic systems. 20 Because of discordance between DDI programs, when pharmacists detect a major DDI and/or any DDI in clinically critical patients, they should confirm that using another DDI program. Although it seems time consuming, this could result in elevated patient safety.…”