Abstract
Background When prescribing medications, physicians should recognize clinically relevant potential drug–drug interactions (DDIs). To improve medication safety, it is important to understand prescribers’ knowledge and opinions pertaining to DDIs. Objective To determine the current DDI information sources used by medical residents, their knowledge of DDIs, their opinions about performance feedback on co-prescription of interacting drugs. Setting Academic hospitals of Mashhad University of Medical Sciences (MUMS) in Iran. Methods A questionnaire containing questions regarding demographic and practice characteristics, DDI information sources, ability to recognize DDIs, and opinions about performance feedback was distributed to medical residents of 22 specialties in eight academic hospitals in Iran. We analyzed their perception pertaining to DDIs, their performance on classifying drug pairs, and we used a linear regression model to assess the association of potential determinants on their DDI knowledge. Main Outcome Measure prescribers’ knowledge and opinions pertaining to DDIs. Results The overall response rate and completion rate for 315 distributed questionnaires were 90% (n = 295) and 86% (n = 281), respectively. Among DDI information sources, books, software on mobile phone or tablet, and Internet were the most commonly-used references. Residents could correctly classify only 41% (5.7/14) of the drug pairs. The regression model showed no significant association between residents’ characteristics and their DDI knowledge. An overwhelming majority of the respondents (n = 268, 95.4%) wished to receive performance feedback on co-prescription of interacting drugs in their prescriptions. They mostly selected information technology-based tools (i.e. short text message and email) as their preferred method of receiving feedback. Conclusion Our findings indicate that prescribers may have poor ability to prevent clinically relevant potential DDI occurrence, and they perceive the need for performance feedback. These findings underline the importance of well-designed computerized alerting systems and delivering performance feedback to improve patient safety.
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References
Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.
Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23:489–97.
Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–8.
Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician’s expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg. 2014;69:157–64.
Malone DC, Liberman JN, Sun D. Effect of an educational outreach program on prescribing potential drug–drug interactions. J Managed Care Pharm. 2013;19:549–57.
Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract. 2009;7:242–7.
Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug–drug interaction database SFINX on prevalence of potentially serious drug–drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69:565–71.
Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166:1009–15.
Strom BL, Schinnar R, Bilker W, Hennessy S, Leonard CE, Pifer E. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID-warfarin co-prescribing as a test case. J Am Med Inform Assoc JAMIA. 2010;17:411–5.
Armstrong EP, Wang SM, Hines LE, Gao S, Patel BV, Malone DC. Evaluation of a drug–drug interaction: fax alert intervention program. BMC Med Inform Decis Mak. 2013;13:32.
Glassman PA, Belperio P, Lanto A, Simon B, Valuck R, Sayers J, et al. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. J Am Med Inform Assoc JAMIA. 2007;14:424–31.
Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.
Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care. Am J Med Qual. 2011;26:145–53.
Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.
Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE, Abarca J, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31:525–36.
Hincapie AL, Warholak TL, Hines LE, Taylor AM, Malone DC. Impact of a drug–drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: a 1-year follow-up. Res Soc Adm Pharm RSAP. 2012;8:472–7.
Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug–drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU. 2014;22:52.
Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30:607–10.
Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27:94–104.
Warholak TL, Menke JM, Hines LE, Murphy JE, Reel S, Malone DC. A drug–drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence. Res Soc Adm Pharm RSAP. 2011;7:16–26.
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
Budtz-Jorgensen E, Keiding N, Grandjean P, Weihe P. Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol. 2007;17:27–35.
Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A, et al. Practitioners’ views on computerized drug–drug interaction alerts in the VA system. J Am Med Inform Assoc JAMIA. 2007;14:56–64.
Abbasi Nazari M, Salamzadeh J, Hajebi G, Gilbert B. The role of clinical pharmacists in educating nurses to reduce drug–food interactions (absorption phase) in hospitalized patients. Iran J Pharm Res IJPR. 2011;10:173–7.
Abbasinazari M, Hajhossein Talasaz A, Eshraghi A, Sahraei Z. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica. 2013;51:482–6.
Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm. 2011;33:281–4.
Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S. Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. Eur J Intern Med. 2013;24:227–33.
Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26:423–36.
Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nursing. 2006;27:118–29.
Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population. Eur J Clin Pharmacol. 2000;56:495–9.
Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.
Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging. 2014;31:527–40.
Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, et al. Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. J Am Pharm Assoc JAPhA. 2004;44:142–51.
Olson KE, O’Brien MA, Rogers WA, Charness N. Diffusion of technology: frequency of use for younger and older adults. Ageing Int. 2011;36:123–45.
Ko Y, Malone DC, D’Agostino JV, Skrepnek GH, Armstrong EP, Brown M, et al. Potential determinants of prescribers’ drug–drug interaction knowledge. Res Soc Adm Pharm RSAP. 2008;4:355–66.
Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharm. 2011;9:364–77.
Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm. 2016;38:1052–6.
Nabovati E, Vakili-Arki H, Taherzadeh Z, Saberi MR, Abu-Hanna A, Eslami S. Incidence rate and pattern of clinically relevant potential drug–drug interactions in a large outpatient population of a developing country. Res Pharm Sci. 2016;11:233–42.
Stoll P, Kopittke L. Potential drug–drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm. 2015;37:475–84.
Acknowledgements
The authors would like to acknowledge Prof. Daniel C. Malone, Dr. Yu Ko and their colleagues for providing us the access to the long version of the survey questionnaire. We would like to thank the experts who were consulted for the revision of the questionnaire. We would also like to extend our appreciation to the medical residents who participated in the survey.
Funding
This study was supported by a grant from Mashhad University of Medical Sciences Research Council.
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The authors declare that they have no conflict of interest.
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Nabovati, E., Vakili-Arki, H., Taherzadeh, Z. et al. A survey of attitudes, practices, and knowledge regarding drug–drug interactions among medical residents in Iran. Int J Clin Pharm 39, 560–568 (2017). https://doi.org/10.1007/s11096-017-0453-3
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DOI: https://doi.org/10.1007/s11096-017-0453-3