Impact of the drug-drug interaction database SFINX on prevalence of potentially serious drug-drug interactions in primary health care

Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital, Huddinge, Karolinska Institutet, 141 86, Stockholm, Sweden, .
European Journal of Clinical Pharmacology (Impact Factor: 2.97). 07/2012; 69(3). DOI: 10.1007/s00228-012-1338-y
Source: PubMed


To investigate the impact of the integration of the drug-drug interaction database SFINX into primary health care records on the prevalence of potentially serious drug-drug interactions.

The study was a controlled before-and-after study on the prevalence of potential drug-drug interactions before and after the implementation of SFINX at 15 primary healthcare centres compared with 5 centres not receiving the intervention. Data on dispensed prescriptions from health care centres were retrieved from the Swedish prescribed drug register and analysed for September-December 2006 (pre-intervention) and September-December 2007 (post-intervention). All drugs dispensed during each 4 month period were regarded as potentially interacting.

Use of SFINX was associated with a 17% decrease, to 1.81 × 10(-3) from 2.15 × 10(-3) interactions per prescribed drug-drug pair, in the prevalence of potentially serious drug-drug interactions (p = 0.042), whereas no significant effect was observed in the control group. The change in prevalence of potentially serious drug-drug interactions did not differ significantly between the two study groups. The majority of drug-drug interactions identified were related to chelate formation.

Prescriptions resulting in potentially serious drug-drug interactions were significantly reduced after integration of the drug-drug interaction database SFINX into electronic health records in primary care. Further studies are needed to demonstrate the effectiveness of drug-drug interaction warning systems.

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Available from: Bjorn Wettermark, Mar 23, 2015
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    • "Drug–drug interactions (DDIs) can cause drug-related problems , both adverse drug reactions and loss of therapeutic thereby improve quality of prescribing, reducing drug related problems and enhancing patient safety [2] [3]. A CDSS containing information with high specificity about drug interactions has also been deemed clinically useful in DDI detection [4] [5]. "
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    ABSTRACT: Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome.
    International Journal of Medical Informatics 01/2015; 84(5). DOI:10.1016/j.ijmedinf.2015.01.013 · 2.00 Impact Factor
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    • "Alternatively, an evaluation of the outcomes pre- and post-introduction of a CDS system in one setting may provide useful information on the effect of CDS alerts. Indeed, a recent controlled trial demonstrated a reduction in the prevalence of potentially dangerous drug–drug interactions, after implementation of a drug–drug interaction database [59]. However, a given CDS system may produce different responses in different healthcare settings [60]. "
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    ABSTRACT: Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority. A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop. We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures. We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.
    BMC Medical Informatics and Decision Making 10/2013; 13(1):111. DOI:10.1186/1472-6947-13-111 · 1.83 Impact Factor
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    ABSTRACT: Information must be collected, evaluated and utilized to support every qualified activity. Medicine, with a written scientific tradition stretching back more than 2,000 years, is no exception. Here, we discuss a number of important items associated with the establishment of a drug information centre run by clinical pharmacologists and information pharmacists, serving a broad demand, mainly among clinical specialists. The working methods include a professional literature search, critical evaluation of the material, writing a structured answer, quality control, feedback to the inquirer and storage in a database which is publicly available. One can foresee even more complex systems wherein a number of active and specialized databases communicate to provide relevant advice and support at the point of care, supplying information on drug recommendations, reimbursement, environmental aspects, antimicrobial resistance, pharmacogenetics and adverse effects, and linked to a list of prescribed drugs for the individual patient. This will be possible in both rich and poor countries through the application of modern and developing information technology. However, research on the best and safest methods of such decision support systems will be needed to ensure that they really do improve the quality of drug prescribing and use.
    European Journal of Clinical Pharmacology 05/2013; 69 Suppl 1(S1):65-72. DOI:10.1007/s00228-013-1484-x · 2.97 Impact Factor
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