Peng Catherine C, Glassman Peter A, Marks Iny R, Fowler Curtis, Castiglione Brenda, Good Chester B
J Manag Care Pharm. 2003 Nov-Dec;9(6):513-22. doi: 10.18553/jmcp.2003.9.6.513.
To determine the incidence of clinically relevant potential drug-drug interactions (DDIs) in a large population of ambulatory patients utilizing a computerized, retrospective drug utilization review (DUR) program followed by clinical pharmacist audit.
The drug claims database included approximately 2.9 million patients with more than 30 million prescriptions dispensed in the 12-month period from September 2001 through August 2002. Cases were identified by a computerized, retrospective DUR program with embedded triggers to detect 69 prespecified potentially serious DDIs, with "serious" defined as an interaction that would likely require a change in therapy or use of additional clinical or laboratory monitoring. Two types of automated, computerized assessments were conducted: the first simply detected coprescribed drug pairs, and the second assessment used more sophisticated filters to reduce false positive alerts for coprescribed drug pairs. Clinical pharmacist audit then determined the final incidence of clinically relevant warnings; in this audit, coprescribed drug pairs were defined as clinically relevant if they could cause potentially serious DDIs.
Eighteen drug pairs had insufficient cases for inclusion, leaving 51 drug pairs for evaluation. A total of 244,703 cases of potential DDIs were identified (0.8% of total prescription claims) by simple automated screens. More sophisticated DDI filters reduced the 244,703 potential DDIs by 70.8%, to a total of 65,544 pairs (0.2% of total prescription claims). Clinical pharmacist review reduced the number of potential DDIs by an additional 80.6%, to 12,722 drug pairs (0.04% of total prescription claims) deemed clinically relevant. The combination of sophisticated DDI filters and clinical pharmacist review reduced the incidence of potentially serious DDIs by 94.3%.
The incidence of potentially serious DDIs is relatively low (less than 1%) among ambulatory patients; however, the incidence depends on the method of case finding. Retrospective DUR programs, especially those with additional automated filters or that utilize additional pharmacist review, appear to be important screening tools in determining true rates of coprescribed drug pairs that can lead to potentially serious DDIs.
通过计算机化的回顾性药物利用审查(DUR)程序并随后进行临床药师审核,确定大量门诊患者中具有临床相关性的潜在药物相互作用(DDIs)的发生率。
药物索赔数据库包含在2001年9月至2002年8月的12个月期间分发的约290万患者的3000多万张处方。通过计算机化的回顾性DUR程序识别病例,该程序带有嵌入式触发器以检测69种预先指定的潜在严重DDIs,其中“严重”定义为可能需要改变治疗或使用额外临床或实验室监测的相互作用。进行了两种类型的自动化计算机评估:第一种只是简单地检测同时开具的药物对,第二种评估使用更复杂的过滤器来减少同时开具的药物对的假阳性警报。然后临床药师审核确定具有临床相关性警告的最终发生率;在此次审核中,如果同时开具的药物对可能导致潜在严重DDIs,则将其定义为具有临床相关性。
18种药物对的病例数不足,无法纳入,剩下51种药物对进行评估。通过简单的自动化筛查共识别出244,703例潜在DDIs(占总处方索赔的0.8%)。更复杂的DDI过滤器将244,703例潜在DDIs减少了70.8%,至总共65,544对(占总处方索赔的0.2%)。临床药师审核又将潜在DDIs的数量减少了80.6%,至12,722对药物对(占总处方索赔的0.04%),这些被认为具有临床相关性。复杂的DDI过滤器和临床药师审核相结合,将潜在严重DDIs的发生率降低了94.3%。
门诊患者中潜在严重DDIs的发生率相对较低(低于1%);然而,发生率取决于病例发现方法。回顾性DUR程序,尤其是那些具有额外自动化过滤器或利用额外药师审核的程序,似乎是确定可能导致潜在严重DDIs的同时开具药物对的真实发生率的重要筛查工具。