Potential Determinants of Drug-Drug Interaction Associated Dispensing in Community Pharmacies

Abstract

Although the number of clinically relevant drug-drug interactions (DDIs) is probably low, DDIs may be responsible for a substantial number of hospital admissions. In some countries, the pharmacist is responsible for preventing the use of unsafe or non-effective drug regimens. Specifically they should avoid the dispensing of combinations of drugs that may cause serious DDIs. In order to assess the determinants related to community pharmacies and associated with these dispensings, a systematic literature review was conducted. Medline and International Pharmaceutical Abstracts were searched for articles published in English between 1993 and 2003. Additional relevant articles were identified by screening the reference lists of relevant articles. Seven papers were located. The determinants described in the literature were divided into three groups. The first group focussed on the relationship between the pharmacist and the prescriber. The number of prescribers is of importance as well as the number of dispensing pharmacies. Both a high number of primary care physicians and multiple dispensing pharmacies increased the risk of DDIs. The availability, quality and sensitivity of the medication surveillance software appeared to be a second important determinant. Both too many and too few signals increased the risk of dispensing interacting drugs. The third group of determinants was related to the pharmacist and pharmacy organisation. Signals from the surveillance program are usually judged first by technicians and subsequently managed by the pharmacist. Consequently, knowledge, instructions and supervision are important determinants. A fourth group of determinants was identified in literature assessing interventions by pharmacists, including interventions for DDIs. A higher workload was associated with lower intervention rates, which indicated a higher risk of dispensing interacting drugs. The determinants identified in this review can be used to develop strategies to minimise patient harm resulting from DDIs. Further assessment of the relation between these determinants and the dispensing of DDIs and of the relation between DDI-associated dispensing and patient harm is recommended.

Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland

“…The use of computer software for prospective medication surveillance is a very common approach to avoiding medication errors [1]. In our study, all community pharmacies were equipped with drug-interaction surveillance software, and most of them (90.2%) used it to identify potential drug interactions.…”

“…Potential drug interactions are highly prevalent, but the number of adverse drug reactions caused by drug interactions is probably low [1][2][3][4]. Reported incidences in outpatients range from 9.2% to 70.3% for drug interactions of any severity, and from 1.2% to 23.3% for those considered of major relevance [5][6][7][8][9][10][11].…”

Manejo de las interacciones medicamentosas con beta-bloqueantes: la formación continuada tiene impacto a corto plazo

“…Simultaneously, pharmacies could be obliged to use medication surveillance screening programs, which is already the case in for example the Netherlands. 29 However, those programs will never be able to replace pharmacists' reasoning and decision making. Pharmacists, as drug experts, should take up their responsibility of detecting and preventing DRPs, if they wish to claim a role in DRP assessment.…”

Doctor and pharmacist — back to the apothecary!

“…74 A systematic literature review concluded that the number of prescribers, and the number of dispensing pharmacies, is important in determining the prevalence of clinically relevant drug-drug interactions. 75 An Australian study also found that having multiple prescribers increased patients' key medicationrelated risk factors and was associated with poor health outcomes. 76 Non-medical prescribing can lead to too many specialist health professionals, each prescribing medicines, without the oversight of a general practitioner.…”