Morera Tomas, Gervasini Guillermo, Carrillo Juan A, Benitez Julio
Department of Pharmacology and Psychiatry, University of Extremadura Medical School, Badajoz, Spain.
Ann Pharmacother. 2004 Jul-Aug;38(7-8):1301-6. doi: 10.1345/aph.1D549. Epub 2004 Jun 3.
Drug-drug interactions are one of the main causes of adverse effects. These events have been studied most often in hospital settings; however, investigations on prescribing based on community practice have shown a high prevalence rate of potential drug interactions.
To develop a computerized system able to trace drug interactions quickly through the identification of clinicians issuing potentially unsafe prescriptions.
We retrospectively evaluated hazardous concomitant prescriptions of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and azole antifungals, which were invoiced through 9 months of 2001 within an outpatient setting. The study was conducted in Badajoz, a southern Spanish province, and was divided in three 3-month periods according to the release of 2 warning notes on this drug combination by the Spanish Drug Agency. Prescriptions written during this period were optically scanned each month, and the resulting information, including data from patients, physicians, and drugs involved, was converted to a database and searched for potentially unsafe coprescriptions.
A total of 8342711 prescriptions were invoiced in the period of study, 174 of which were for a statin-azole combination. The number of these prescriptions remained fairly constant during periods I and II (63 and 71, respectively), decreasing to 40 in period III. Some clinicians (12.6%) repeatedly prescribed a hazardous drug combination at some point in this study, whereas 18 of 171 patients who received the hazardous coprescription at any time did so repeatedly within a given period. The impact of drug alerts was remarkably deeper in urban rather than rural care centers.
The computerized drug prescription handling system described here is able to readily identify physicians and patients who issue/consume hazardous drug combinations, thus allowing both the possibility of individually informing the healthcare professionals involved and early detection of adverse effects.
药物相互作用是不良反应的主要原因之一。这些事件大多在医院环境中进行研究；然而，基于社区实践的处方调查显示，潜在药物相互作用的发生率很高。
开发一种计算机化系统，能够通过识别开具潜在不安全处方的临床医生来快速追踪药物相互作用。
我们回顾性评估了2001年9个月内在门诊环境中开具发票的羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）和唑类抗真菌药的危险联合处方。该研究在西班牙南部省份巴达霍斯进行，根据西班牙药品管理局发布的关于这种药物组合的2份警告通知，分为三个3个月的时间段。在此期间开具的处方每月进行光学扫描，所得信息，包括患者、医生和所涉药物的数据，被转换为数据库，并搜索潜在不安全的联合处方。
在研究期间共开具了8342711份处方，其中174份为他汀类药物与唑类药物的组合。这些处方的数量在第一阶段和第二阶段保持相当稳定（分别为63份和71份），在第三阶段降至40份。一些临床医生（12.6%）在本研究的某个时间点反复开具危险的药物组合，而在任何时候接受危险联合处方的171名患者中，有18名在给定期间内反复接受该处方。药物警报在城市护理中心的影响明显比农村护理中心更深。
这里描述的计算机化药物处方处理系统能够很容易地识别开具/使用危险药物组合的医生和患者，从而既可以单独通知相关医疗专业人员，又可以早期发现不良反应。
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