Ko Yu, Malone Daniel C, Skrepnek Grant H, Armstrong Edward P, Murphy John E, Abarca Jacob, Rehfeld Rick A, Reel Sally J, Woosley Raymond L
Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
Drug Saf. 2008;31(6):525-36. doi: 10.2165/00002018-200831060-00007.
Given the high prevalence of medication use in the US, the risk of drug-drug interactions (DDIs) and potential for patient harm is of concern. Despite the rise in technologies to identify potential DDIs, the ability of physicians and other prescribers to recognize potential DDIs is essential to reduce their occurrence. The objectives of this study were to assess prescribers' ability to recognize potential clinically significant DDIs and to examine the sources of information they use to identify potential DDIs and prescribers' opinions on the usefulness of various DDI information sources.
A postal questionnaire was developed to assess prescriber knowledge of medications that may interact and prescribers' usual sources of DDI information. Recipients were asked to classify 14 drug pairs as 'contraindicated', 'may be used together but with monitoring' or 'no interaction'. A response option of 'not sure' was also provided. The questionnaires were sent to a national sample of 12 500 prescribers based on past history of prescribing drugs associated with known potential for DDI, who were identified using data from a pharmacy benefit manager covering over 50 million individuals.
Usable questionnaires were obtained from 950 prescribers. The percentage of prescribers who correctly classified specific drug pairs ranged from 18.2% for warfarin and cimetidine to 81.2% for paracetamol (acetaminophen) with codeine and amoxicillin, with 42.7% of all combinations classified correctly. The number of drug pairs correctly classified by the prescribers ranged from 0 to 13. For half of the drug pairs over one-third of the respondents answered 'not sure'; among those drug pairs, two were contraindicated. When asked what source was used to learn more about a potential DDI, a quarter of the prescribers reported using personal digital assistants and another quarter used printed material. The majority of the prescribers (68.4%) reported that they were usually informed by pharmacists about their patients' potential exposure to DDIs. Compared with the prescribers who used other sources, those who used computerized DDI alerts as their usual source of DDI information consistently gave a lower rating score to the five statements that assessed the usefulness of the information.
This study suggests that prescribers' knowledge of potential clinically significant DDIs is generally poor. These findings are supported by other research and emphasize the need to develop systems that alert prescribers about potential interactions that are clinically relevant. Physicians most commonly reported learning about potential DDIs from pharmacists, suggesting further work is needed to improve the drug-prescribing process to identify potential safety issues earlier in the medication use process.
鉴于美国药物使用的高普及率，药物相互作用（DDIs）的风险以及对患者造成伤害的可能性令人担忧。尽管识别潜在药物相互作用的技术有所增加，但医生和其他开处方者识别潜在药物相互作用的能力对于减少其发生至关重要。本研究的目的是评估开处方者识别潜在临床显著药物相互作用的能力，检查他们用于识别潜在药物相互作用的信息来源，以及开处方者对各种药物相互作用信息来源有用性的看法。
制定了一份邮政调查问卷，以评估开处方者对可能相互作用药物的了解以及他们通常的药物相互作用信息来源。要求受访者将14对药物分类为“禁忌”、“可一起使用但需监测”或“无相互作用”。还提供了“不确定”的回答选项。根据与已知潜在药物相互作用相关的开药历史，从一家涵盖超过5000万人的药房福利管理机构的数据中识别出12500名开处方者，并向其全国样本发送问卷。
从950名开处方者那里获得了可用问卷。正确分类特定药物对的开处方者百分比范围从华法林与西咪替丁的18.2%到对乙酰氨基酚（醋氨酚）与可待因和阿莫西林的81.2%，所有组合的正确分类率为42.7%。开处方者正确分类的药物对数量从0到13不等。对于超过三分之一的受访者回答“不确定”的一半药物对中，有两对是禁忌的。当被问及使用什么来源来了解更多关于潜在药物相互作用的信息时，四分之一的开处方者报告使用个人数字助理，另有四分之一使用印刷材料。大多数开处方者（68.4%）报告说他们通常由药剂师告知其患者潜在的药物相互作用暴露情况。与使用其他来源的开处方者相比，那些将计算机化药物相互作用警报作为其通常的药物相互作用信息来源的人，对评估信息有用性的五项陈述的评分始终较低。
本研究表明，开处方者对潜在临床显著药物相互作用的了解普遍较差。这些发现得到了其他研究的支持，并强调需要开发系统来提醒开处方者注意临床相关的潜在相互作用。医生最常报告从药剂师那里了解潜在药物相互作用，这表明需要进一步开展工作以改进开药过程，以便在用药过程中更早地识别潜在安全问题。
