An important part of the daily job of community pharmacists is evaluating the clinical significance of drug-drug interactions (DDIs) and responding to computer-generated DDI alerts. However, a panel of nine pharmacists from one community pharmacy chain deemed most (81 percent) of these DDI alerts insignificant. Either the patient was no longer taking the medication with which the new prescription interacted, or the prescription was being refilled and the interaction had already been evaluated. The pharmacists generally had no reason to take any action other than to override the alert.
Although pharmacists did not spend much time attending to these alerts, they still had to divert attention from other tasks that might benefit the patient, notes John E. Murphy, Pharm.D., of the University of Arizona. Dr. Murphy and his colleagues recommend that online prospective drug-use review (OPDUR) systems and internal pharmacy alert systems be redesigned to make them more useful to pharmacists.
In a study that was supported in part by the Agency for Healthcare Research and Quality (HS10385), the researchers had pharmacy students observe daily pharmacy practice and collect data on DDI alerts. They also surveyed the panel of pharmacists about how much time they spent dealing with DDIs and the types of alerts overridden. The pharmacists all used OPDUR systems commonly used in pharmacies and the same internal pharmacy system software.
The pharmacists overrode all 51 DDI alerts generated by the computer. Drug interactions for which there were repeated alerts involved antibiotics, diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, and potassium replacement products. Most pharmacists spent from less than a half hour to an hour of an 8-hour shift overriding interactions they deemed not clinically significant. A mean of 74 percent of the alerts were overridden with no further action taken. The patient was warned and the medication accepted in 19 percent of cases, the physician consulted and the drug left unchanged in 4 percent of cases, and the physician consulted and drug changed in 3 percent of cases.
See "Community pharmacists' responses to drug-drug interaction alerts," by Dr. Murphy, Ryan A. Forrey, Pharm.D., and Usha Desiraju, Pharm.D., in the July 15, 2004, American Journal of Health-System Pharmacy 61(14), pp. 1484-1487.
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