New research sheds light on how clinicians anticipate drug interactions and make choices about them. Understanding this is especially helpful for older adults who may be on multiple medications.
The investigators evaluated cases between 2013 and 2015 in which drug interactions existed, then assessed how the clinicians responded including tools they used to determine risk and those designed to pinpoint safer treatment options. Of the 45 doctors and pharmacists who participated, six of them didn’t have safety incidents to report.
“Drug-drug interactions are very common, more common than a lot of people outside the healthcare system expect,” said Michael Weiner, MD, a doctor with the US Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine, in a statement. “In the US, these interactions lead to hundreds of thousands of hospitalizations in any given year at an enormous cost. Most of these drug interactions are preventable.”
The team came up with 19 cognitive cues that medical professionals use to detect and make decisions about drug interactions. These cues include:
- information that influenced interpretation of potential severity of drug-drug interaction
- type or degree of side effects or harms
- patient’s expected duration of exposure to interaction
- patient-specific conditions that may increase risk of interaction
- patient’s medical need for the medications
- characteristics of safer medications
“This study was needed because we previously didn’t have a great understanding of how clinicians actually make decisions in assessing these interactions. No one had really taken apart the thinking process step-by-step to understand it from the beginning to the end. There’s a patient, there’s a drug and another drug. There is now a potential interaction. There’s been a decision about how to resolve it following an assessment and then a resolution process. Understanding all this is very important if we are hoping to design improvements to the medical system that enhance patient safety,” Weiner said.
Electronic health records (EHRs) can alert healthcare professionals to interactions, but sometimes a patient’s data isn’t in a single system.
Now that clinicians better understand their processes, it could lead to EHR system alerts that provide better, more actionable and more timely information.
The study also included recommendations for designing alerts, which included timing on expected ranges of drug interactions, allowing clinicians to see references alongside the alert, displaying alternatives and giving recommendations on the alert based on an individual’s characteristics.
The report was published last month in BMJ Open.
