Berger Florine A, van der Sijs Heleen, van Gelder Teun, van den Bemt Patricia M L A
Department of Hospital Pharmacy, Erasmus University Medical Centre, Department of Hospital Pharmacy, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Ther Adv Drug Saf. 2021 Feb 24;12:2042098621996098. doi: 10.1177/2042098621996098. eCollection 2021.
The handling of drug-drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists.
An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome.
Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49-1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool.
The CDS tool might be a first step to developing a tool to manage QT-DDIs a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts.
Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug-drug interactions (QT-DDIs). In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs a structured approach.
关于QTc延长的药物相互作用（QT-DDIs）的处理尚无明确界定。临床决策支持（CDS）工具将有助于QT-DDIs的风险管理。因此，我们研究了一种CDS工具对药剂师考虑进行干预的QT-DDIs比例的影响。
在荷兰的20家社区药店采用前后设计进行了一项干预研究。纳入了在三个月前后期间发生的所有QT-DDIs。研究了使用CDS工具支持处理QT-DDIs的影响。对于每个QT-DDI，从药房信息系统中提取QT-DDI的处理情况和患者特征。主要结局是进行干预的QT-DDIs比例。次要结局是干预类型和处理QT-DDIs相关的时间。采用逻辑回归分析来分析主要结局。
纳入了CDS工具使用前的244例QT-DDIs和CDS工具使用后的157例QT-DDIs。药剂师在CDS工具使用前和使用后分别对43.0%和35.7%的QT-DDIs进行了干预（优势比0.74；95%置信区间0.49-1.11）。替换相互作用的药物是最常见的干预措施。药剂师在CDS工具使用前处理QT-DDIs花费20.8±3.5分钟（均值±标准差），在CDS工具使用后减少至14.9±2.4分钟（均值±标准差）。其中，在CDS工具上花费4.5±0.7分钟（均值±标准差）。
CDS工具可能是开发一种以结构化方法管理QT-DDIs工具的第一步。需要改进该工具以提高其诊断价值并减少多余的QT-DDI警报。
几种药物具有导致心律紊乱作为罕见副作用的能力。这种心律紊乱称为QTc间期延长。它可能导致心脏骤停。对于医生和药剂师等医疗保健专业人员来说，很难决定同时使用两种或更多种这些延长QT的药物治疗患者是否安全。最近，开发了一种工具来支持这些QT药物相互作用（QT-DDIs）的风险管理。在本研究中，我们研究了该工具对药剂师考虑进行干预的QT-DDIs比例的影响。在荷兰的20家社区药店采用前后设计进行了一项干预研究。纳入了在3个月前后期间发生的所有QT-DDIs。纳入了工具实施前的244例QT-DDIs和工具实施后的157例QT-DDIs。在工具实施前，药剂师对43.0%的QT-DDIs进行了干预，在工具实施后为35.7%。替换其中一种相互作用的药物是最常见的干预措施。使用该工具时，药剂师处理QT-DDIs花费的时间更少。临床决策支持工具可能是开发一种以结构化方法管理QT-DDIs工具的第一步。
