Physicians' Decisions to Override Computerized Drug Alerts in Primary Care

Weingart, Saul N.; Tóth, Mária; Sands, Daniel Z.; Aronson, Mark D.; Davis, Roger B.; Phillips, Russell S.

doi:10.1001/archinte.163.21.2625

Cited by 433 publications

(371 citation statements)

References 14 publications

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“…5 Several alternative suggestions to reduce alert overload were made by our study prescribers. Similar to previous reports, 14 prescribers in our study suggested suppressing alerts for renewals of medication combinations that patients currently tolerate. Providers in our study often noted that short-term courses of therapy would continue to arise in the alerts, suggesting that the time frame for medication history on which the drug alerts are run should be evaluated.…”

Section: Discussionsupporting

confidence: 90%

A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care

et al. 2008

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OBJECTIVES:The objective of this paper was to describe primary care prescribers' perspectives on electronic prescribing drug alerts at the point of prescribing. DESIGN:We used a mixed-method study which included clinician surveys (web-based and paper) and focus groups with prescribers and staff.PARTICIPANTS: Prescribers (n=157) working in one of 64 practices using 1 of 6 e-prescribing technologies in 6 US states completed the quantitative survey and 276 prescribers and staff participated in focus groups. MEASUREMENTS:The study measures self-reported frequency of overriding of drug alerts; open-ended responses to: "What do you think of the drug alerts your software generates for you?" RESULTS: More than 40% of prescribers indicated they override drug-drug interactions most of the time or always (range by e-prescribing system, 25% to 50%). Participants indicated that the software and the interaction alerts were beneficial to patient safety and valued seeing drug-drug interactions for medications prescribed by others. However, they noted that alerts are too sensitive and often unnecessary. Participant suggestions included: (1) run drug alerts on an active medication list and (2) allow prescribers to set the threshold for severity of alerts.CONCLUSIONS: Primary care prescribers recognize the patient safety value of drug prescribing alerts embedded within electronic prescribing software. Improvements to increase specificity and reduce alert overload are needed.

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Section: Discussionsupporting

confidence: 90%

A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care

et al. 2008

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“…Studies may be conducted in silico, in vitro or in vivo, the latter comprising formal pharmacokinetic interaction studies in animals and humans, or as reports of clinical observations.The assessment of these studies is seldom explicit, and there is lack of consistency and considerable disparity between resources [2][3][4][5][6]. For example, in a recent study of four international drug interaction compendia, between 14% and 44% of the interactions classified as major in any one compendium were not listed in other compendia [4].Thus, interpreting the clinical relevance of a given perpetrator is often difficult, particularly for healthcare providers subject to 'information overload' and 'alert fatigue' [7,8]. Computerized DDI checkers at the point of prescribing appear no better, delivering alerts that are frequently irrelevant to clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Perpetrators of pharmacokinetic drug–drug interactions arising from altered cytochrome P450 activity: a criteria‐based assessment

Polasek

Lin

Miners

et al. 2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Many drugs inhibit or induce cytochrome P450 enzymes (CYP) to cause clinically significant changes in the concentrations of other drugs, i.e.'perpetrate' pharmacokinetic drug-drug interactions (PK-DDIs).• Tables that list the substrates, inhibitors and inducers of CYP are common, but they lack consistency and are constructed from evidence of variable quality. WHAT THIS STUDY ADDS• This is the first study to catalogue important perpetrators of PK-DDIs using objective criteria and clinical pharmacokinetic drug interaction studies. This information is intended to inform clinical decisions on PK-DDIs.• Existing tables of CYP inhibitors and inducers have low sensitivity and low positive predictive value in identifying the major perpetrators of PK-DDIs. • Several drugs were identified which potentially perpetrate CYP-mediated PK-DDIs, but quality clinical pharmacokinetic interaction studies are lacking. This information may be used to inform future research. AIMSTo catalogue the perpetrators of CYP-mediated pharmacokinetic drug-drug interactions (PK-DDIs) using clinically relevant criteria, and to compare this with an analogous catalogue. METHODSCandidate inhibitors and inducers of CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A ('perpetrators') were evaluated using published clinical pharmacokinetic interaction studies. Studies were selected on the basis of Նsix human subjects, use of a validated in vivo probe substrate for the CYP enzyme, and clinically relevant dosing. Inhibitors were described according to the FDA classifications of strong, moderate or weak, whereas inducers were classified as major (Նtwofold decrease in AUC) or weak (

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“…Decision Support Systems have been widely implemented and adopted in commercial fields 52 ; however their acceptance within the medical domain remains limited 53,54,55,56 . This review aimed to provide clinicians and policy makers with a better understanding of the methodologies CDSSs employ as the development and deployment of systems that can meaningful support clinicians in practice requires their collaboration.…”

Section: Discussionmentioning

confidence: 99%