Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Abstract

*Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixtyfour percent of the potential DDIs were of 'Moderate' type and 58% had a 'Delayed' onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a 'Good' documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy. IMPACTO DE UNA INTERVENCION EDUCATIVA EN EL ESQUEMA E INCIDENCIAS DE INTERACCIONES MEDICAMENTOSAS POTENCIALES EN NEPAL RESUMENObjetivo: Estudiar el impacto de una intervención educativa en el esquema y la incidencia de las interacciones medicamentosas potenciales (DDI). Método: Se incluyó a todos los pacientes que visitaron el servicio de medicina interna del Hospital Universitario de Manipal. Los detalles de los pacientes se recogieron utilizando un formulario de perfil de paciente y los datos fueron analizados utilizando la base de datos electrónica Micromedex. Se realizó una intervención mediante una reunión clínica y discusión personal. El grupo diana eran los médicos y los enfermeros. Resultados: Se estudiaron 435 pacientes durante la pre-intervención y 445 durante la post-intervención. Las incidencia de DDI potenciales fue del 53% (pre-intervención) y 41% (post-intervención) [chi cuadrado=11,27, p=0,001]. La media de medicamentos por paciente fue de 8,53 (preintervención) y 7,32 (post-intervención) [t=3,493, p=0,001]. El 64% de las DDI potenciales eran de tipo 'Moderadas' y el 58% tenía una iniciación 'Retrasada' en ambas fases. El 70% de las DDI potenciales durante la fase de pre-intervención y el 61% en la post-intervención tenían un estado de documentación 'Bueno'. Mecanismo...

A study of potential drug-drug interactions among critically ill patients at a tertiary care hospital

“…[1][2][3][5][6][7][8][9][12][13][14][15][16][17][18] The present study also shows a statistical association between polypharmacy and number of pDDI.…”

“…[5][6][7]9,12,[15][16][17] Hence, we can say that pDDI are more common in elderly probably due to age related physiological, pharmacokinetic and pharmacodynamic changes.…”

“…5,8,[15][16][17] Since majority of the patients suffered from cardiovascular disorder and the number of drugs from cardiovascular system were more it can be the reason for the high incidence of pDDI occurring in this group.…”

“…1,8,10,12,15,18 In risk rating, category C was most common which required monitoring of therapy and was found to be similar to a study done by Doubova et al 3 According to mechanism of interactions, most of the pDDI were pharmacodynamic which was also seen with studies done in India using Medscape drug checker software. 9,16 This study is among the few studies done in India for assessing the prevalence of pDDI using drug interaction softwares'. This study had a few limitations.…”

Drug-drug interactions and their predictors: results from Indian elderly inpatients

“…There are few studies that can be directly compared with this study because these studies have also used Micromedex database to check the severity of interaction. These few studies had shown DIs in the range of 1.5-28% of severe drug interactions in hospitalized elderly patients 8,9,10,11. Only one study has reported a very low rate (1.5%) 8.…”