Matos Adriana, Bankes David L, Bain Kevin T, Ballinghoff Tyler, Turgeon Jacques
Tabula Rasa HealthCare, Applied Precision Pharmacotherapy Institute, Moorestown, NJ 08057, USA.
Biophilia, LLC, Swedesboro, NJ 08085, USA.
Pharmacy (Basel). 2020 Aug 25;8(3):154. doi: 10.3390/pharmacy8030154.
Polypharmacy is a common phenomenon among adults using opioids, which may influence the frequency, severity, and complexity of drug-drug interactions (DDIs) experienced. Clinicians must be able to easily identify and resolve DDIs since opioid-related DDIs are common and can be life-threatening. Given that clinicians often rely on technological aids-such as clinical decision support systems (CDSS) and drug interaction software-to identify and resolve DDIs in patients with complex drug regimens, this narrative review provides an appraisal of the performance of existing technologies. Opioid-specific CDSS have several system- and content-related limitations that need to be overcome. Specifically, we found that these CDSS often analyze DDIs in a pairwise manner, do not account for relevant pharmacogenomic results, and do not integrate well with electronic health records. In the context of polypharmacy, existing systems may encourage inadvertent serious alert dismissal due to the generation of multiple incoherent alerts. Future technological systems should minimize alert fatigue, limit manual input, allow for simultaneous multidrug interaction assessments, incorporate pharmacogenomic data, conduct iterative risk simulations, and integrate seamlessly with normal workflow.
多重用药是使用阿片类药物的成年人中的常见现象，这可能会影响所经历的药物相互作用（DDIs）的频率、严重程度和复杂性。由于与阿片类药物相关的药物相互作用很常见且可能危及生命，临床医生必须能够轻松识别并解决这些相互作用。鉴于临床医生通常依靠技术辅助手段，如临床决策支持系统（CDSS）和药物相互作用软件，来识别和解决药物治疗方案复杂的患者中的药物相互作用，本叙述性综述对现有技术的性能进行了评估。阿片类药物特异性临床决策支持系统存在一些与系统和内容相关的局限性，需要加以克服。具体而言，我们发现这些临床决策支持系统通常以两两配对的方式分析药物相互作用，不考虑相关的药物基因组学结果，并且与电子健康记录的整合效果不佳。在多重用药的情况下，现有系统可能会因产生多个不连贯的警报而导致无意中严重忽略警报。未来的技术系统应尽量减少警报疲劳，限制手动输入，允许同时进行多种药物相互作用评估，纳入药物基因组学数据，进行迭代风险模拟，并与正常工作流程无缝集成。
