Hong Casara, Legal Michael, Bagri Harkaryn, Lau Louise, Dahri Karen
, BSc, PharmD, ACPR, is with St Paul's Hospital, Providence Health Care, Vancouver, British Columbia.
, BSc(Pharm), PharmD, ACPR, FCSHP, is with St Paul's Hospital, Providence Health Care, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
Can J Hosp Pharm. 2022 Jul 4;75(3):193-200. doi: 10.4212/cjhp.3171. eCollection 2022 Summer.
Clinical decision support systems (CDSS) are used by pharmacists to assist in managing drug-drug interactions (DDIs). However, previous research suggests that such systems may perform suboptimally in providing clinically relevant information in practice.
The primary objective of this study was to develop a novel DDI management tool to reflect the clinical thought process that a pharmacist uses when assessing a DDI. The secondary objective was to investigate practitioners' perceptions of this tool.
This study was conducted in 3 phases: development of the DDI management tool, implementation of the tool in clinical practice, and collection of practitioners' opinions of the tool through an online qualitative survey (although because of circumstances related to the COVID-19 pandemic, the study population for the survey phase included only pharmacy residents). A comprehensive literature search and analysis by an expert panel provided underlying context for the DDI management tool. The tool was validated through simulation against a known list of DDIs before implementation into practice by hospital pharmacists and pharmacy residents. Participating pharmacy residents were invited to provide feedback on the tool. Survey results were analyzed using descriptive statistics.
The novel tool that was developed in this study (called TLC-Act) consisted of components important to a pharmacist when assessing a DDI, including the duration of concomitant use of the interacting medications and patient-specific risk factors. Study participants implemented the tool in clinical practice for a total of 6 weeks. Of the 28 pharmacy residents surveyed, 15 (54%) submitted a response, of whom 11 (73%) found the TLC-Act tool to be slightly more useful for assessing a DDI than usual care with the CDSS alone.
The TLC-Act tool maps out a pharmacist's clinical thought process when assessing a DDI in practice. This novel tool may be more useful than a CDSS alone for managing DDIs, as it takes into account other important factors pertinent to the assessment of a DDI.
临床决策支持系统（CDSS）被药剂师用于协助管理药物相互作用（DDI）。然而，先前的研究表明，此类系统在实际提供临床相关信息方面可能表现欠佳。
本研究的主要目的是开发一种新型的DDI管理工具，以反映药剂师在评估DDI时所使用的临床思维过程。次要目的是调查从业者对该工具的看法。
本研究分三个阶段进行：开发DDI管理工具、在临床实践中实施该工具以及通过在线定性调查收集从业者对该工具的意见（尽管由于与2019年冠状病毒病大流行相关的情况，调查阶段的研究人群仅包括药学住院医师）。由专家小组进行的全面文献检索和分析为DDI管理工具提供了基础背景。在医院药剂师和药学住院医师将该工具应用于实践之前，通过与已知的DDI列表进行模拟验证。邀请参与的药学住院医师对该工具提供反馈。使用描述性统计分析调查结果。
本研究中开发的新型工具（称为TLC-Act）包括药剂师在评估DDI时重要的组成部分，包括相互作用药物的联合使用持续时间和患者特定的风险因素。研究参与者在临床实践中总共使用该工具6周。在接受调查的28名药学住院医师中，15名（54%）提交了回复，其中11名（73%）发现TLC-Act工具在评估DDI方面比仅使用CDSS的常规护理略有用。
TLC-Act工具描绘了药剂师在实践中评估DDI时的临床思维过程。这种新型工具在管理DDI方面可能比单独的CDSS更有用，因为它考虑了与DDI评估相关的其他重要因素。
