[Physician - Pharmacist Communication about Potentially Severe Drug Interactions].

INTRODUCTION

Potentially serious drug interactions are often detected by pharmacists. In such cases fast communication with the General Practitioner (GP) is required. However, contacting physicians by telephone is often difficult. In a previous project a fax template was developed allowing fast communication of serious drug interactions to the GP. Utilization of the template and interactions detected were assessed in this observational study.

METHODS

All pharmacists and GP in the city of Bremen were informed about the template. Severity of drug interactions was rated by the ABDA classification system (from 1 "contraindication" to 8: "no action recommended"). Participating pharmacists were asked to send an anonymized copy of every template. A descriptive analysis of the interactions, actions recommended by the pharmacists and physicians' reactions was performed.

RESULTS

123 faxes were sent to the Pharmacist's Association in Bremen by 23 pharmacies (1 - 25 fax/pharmacy). In 108/123 cases (severe) interactions were reported. In the remaining cases the interaction could not be verified (n = 7) or unintended double medication (n = 8) was detected. GP gave feedback in 69.4 % (n = 75). The GP followed the recommendations made by the pharmacist changing their original prescription, discontinuing medication and or monitoring patient´s therapy followed the recommendations made by the pharmacist (n = 23). Beside that GP, chose another strategy (n = 15) or gave feedback that the interaction was known and issued the prescription as planned (31.5 %, n = 34). Check back with the patient was rarely recommended (n = 3).

DISCUSSION

Fax templates seem to be an accepted instrument by pharmacists reporting serious drug interactions and able to improve medication safety. Different than intended, pharmacists used template for reporting less severe drug interactions. Attention has to be paid to the risk of over alerting, reporting which can lead to unintended neglect of urgent problems. Pharmacists should therefore be encouraged to report only serious drug interactions.