When Warnings Are Not Enough: Primary Prevention Through Drug Use Review

Lyles, Alan; Zuckerman, Ilene H.; DeSipio, Susan M.; Fulda, Thomas R.

doi:10.1377/hlthaff.17.5.175

Cited by 16 publications

(7 citation statements)

References 21 publications

(14 reference statements)

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“…4 With an aging population, the number of patients on multiple medications will increase and the likelihood of clinically significant DDIs will escalate. 6,20 The need for more specific DDI screening tools increases as the number of prescriptions being filled rises.…”

Section: ■■ Discussionmentioning

confidence: 99%

Evaluation of the Performance of Drug-Drug Interaction Screening Software in Community and Hospital Pharmacies

Abarca

Colón

Wang³

et al. 2006

JMCP

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harmacists play an important role in protecting the public from the dangers posed by potential drug-drug interactions (DDIs), which have been identified as an important subset of medication errors.1 They are uniquely trained to recognize medication-related problems and have the opportunity to review the medication profiles of patients in the inpatient and outpatient setting before dispensing occurs.One of the tools that pharmacists rely on to review medication profiles for DDIs is computerized screening for DDIs. Computerized screening for DDIs and other potential drug-related problems is embedded within most pharmacy computer systems that are used in community and hospital pharmacies and also is included in the prospective, online drug utilization review provided by pharmacy benefit managers. While manual review of medication regimens can be performed by pharmacists, recognition of DDIs without the use of an aid (e.g., drug interaction reference, computer program) only identifies approximately 70% of DDIs in a 2-drug regimen and the proportion decreases substantially as the number of medications increases.2 Thus, computerized DDI screening has the potential to significantly improve the recognition of potentially harmful DDIs beyond what can be achieved with manual review alone. 3Research on the performance of computerized DDI screening software and the references they are based on have found problems in the ability to provide consistent information and screen for clinically significant DDIs. [4][5][6][7][8] For example, in 2001, Hazlet et al. ABSTRACTBACKGROUND: Computerized drug-drug interaction (DDI) screening is widely used to identify potentially harmful drug combinations in the inpatient and outpatient setting.OBJECTIVE: To evaluate the performance of drug-drug interaction (DDI) screening software in identifying select clinically significant DDIs in pharmacy computer systems in community and hospital pharmacies.

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Section: ■■ Discussionmentioning

confidence: 99%

Evaluation of the Performance of Drug-Drug Interaction Screening Software in Community and Hospital Pharmacies

Abarca

Colón

Wang³

et al. 2006

JMCP

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“…Those discrepancies involved 38 (60%) of the patients. • Drug utilization reviews have been promoted as a useful tool to detect and reduce medication errors (Lyles et al, 1998). However, a recent longitudinal ecologic and cohort study of six Medicaid programs that used the same review software in the mid-1990s did not find a reduction in the rate of adverse drug effects or any reduction in the incidence of hospitalization ).…”

Section: Medication Monitoring Errormentioning

confidence: 99%

Medication Errors in Community/Ambulatory Care:

Kuo¹

2007

Journal of Pharmaceutical Finance, Economics & Policy

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This study was to develop estimates of the incidence, severity, and cost of medication errors and to evaluate strategies for reducing medication errors relevant to community/ambulatory care from published literatures. Relevant studies and reviews that assessed medication errors or medication safety were identified through MEDLINE, manual literature search of reference list and recommendations. Studies in peer-reviewed journals from 1995-2005 and earlier major studies were inclued.• Interface between care settings (e.g., prescribing and monitoring) • The ambulatory clinic setting (e.g., prescribing and monitoring) • The community pharmacy setting (e.g., procuring, dispensing) • The home care setting (e.g., administering) • The self-care setting (e.g., administering) • The school setting (e.g., administering) METHODS Search Strategy

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“…2,3 Articles in this Journal and in others have sought to illustrate both the perceived shortcomings and the opportunities in the DUR systems currently in use. [4][5][6] These research reports raise important questions about the gap between current practice and potential gains from drug utilization review. Some suggest that important potential drug interactions were not detected by pDUR systems.…”

Section: Thomas R Fulda Ma; Alan Lyles Scd Mph Bspharm; Mark C mentioning

confidence: 99%

“…4,5 Others contend that current DUR systems fail to "promote [the] appropriate use of medications without having to remove useful but clinically interacting agents from the market." 6 In this article, we focus on the state of the art of pDUR, review what is known about its effectiveness, suggest how emerging technologies may change it, and consider what work may be needed to enhance its utility. Other articles have undertaken a similar task focusing on rDUR.…”

Section: Thomas R Fulda Ma; Alan Lyles Scd Mph Bspharm; Mark C mentioning

confidence: 99%

“…The lack of standardization reflects disagreement on the application of that knowledge to real-world systems and methods. 6 A better approach would involve first rating the "evidence" by degree of quality and reliability. The scored evidence could then be used to develop the most clinically meaningful criteria and circumstances that should generate an alert message.…”

Section: Pharmacists' Performancementioning

confidence: 99%

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