Rick A. Rehfeld

Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially clinically important drug-drug interactions

Background:Drug-drug interactions (DDIs) are preventable medical errors, yet exposure to DDIs continues despite systems that are designed to prevent such exposures. The purpose of this study was to examine pharmacy characteristics that may be associated with dispensed potential DDIs. Methods:This study combined survey data from community pharmacies in 18 metropolitan statistical areas with pharmacy claims submitted to 4 pharmacy benefit managers (PBMs) over a 3-month period from January 1, 2003 to March 31, 2003. Pharmacy characteristics of interest included prescription volume, the number of full-time equivalent pharmacists and pharmacy staff, computer software programs, and the ability to modify those programs with respect to DDI alerts, the use of technologies to assist in receiving, filling and dispensing medication orders, and prescription volume. The dependent variable in this study was the rate of dispensed medications that may interact. Results:A total of 672 pharmacies were included in the analysis. On average (±SD), the respondents filled 1375 ± 691 prescriptions per week, submitted 17,948 ± 23,889 pharmacy claims to the participating PBMs, had 1.2 ± 0.3 full-time equivalent pharmacists per hour open, and 545 (81%) were affiliated with a chain drug store organization. Factors significantly related to an increased risk of dispensing a potential DDI included pharmacist workload (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.028–1.048), pharmacy staffing (OR 1.10; 95% CI: 1.09–1.11), and various technologies (eg, sophisticated telephone systems, internet receipt of orders, and refill requests) that assist with order processing, and the ability to modify DDI alert-screening sensitivity and detailed pharmacological information about DDIs. Conclusions:This study found that there was an increase in the risk of dispensing a potential DDI with higher pharmacist and pharmacy workload, use of specific automation, and dispensing software programs providing alerts and clinical information.

Prescribers' knowledge of and sources of information for potential drug-drug interactions: a postal survey of US prescribers.

AbstractBackground: Given the high prevalence of medication use in the US, the risk of drug-drug interactions (DDIs) and potential for patient harm is of concern. Despite the rise in technologies to identify potential DDIs, the ability of physicians and other prescribers to recognize potential DDIs is essential to reduce their occurrence. The objectives of this study were to assess prescribers’ ability to recognize potential clinically significant DDIs and to examine the sources of information they use to identify potential DDIs and prescribers’ opinions on the usefulness of various DDI information sources. Methods: A postal questionnaire was developed to assess prescriber knowledge of medications that may interact and prescribers’ usual sources of DDI information. Recipients were asked to classify 14 drug pairs as ‘contraindicated’, ‘may be used together but with monitoring’ or ‘no interaction’. A response option of ‘not sure’ was also provided. The questionnaires were sent to a national sample of 12 500 prescribers based on past history of prescribing drugs associated with known potential for DDI, who were identified using data from a pharmacy benefit manager covering over 50 million individuals. Results: Usable questionnaires were obtained from 950 prescribers. The percentage of prescribers who correctly classified specific drug pairs ranged from 18.2% for warfarin and cimetidine to 81.2% for paracetamol (acetaminophen) with codeine and amoxicillin, with 42.7% of all combinations classified correctly. The number of drug pairs correctly classified by the prescribers ranged from 0 to 13. For half of the drug pairs over one-third of the respondents answered ‘not sure’; among those drug pairs, two were contraindicated. When asked what source was used to learn more about a potential DDI, a quarter of the prescribers reported using personal digital assistants and another quarter used printed material. The majority of the prescribers (68.4%) reported that they were usually informed by pharmacists about their patients’ potential exposure to DDIs. Compared with the prescribers who used other sources, those who used computerized DDI alerts as their usual source of DDI information consistently gave a lower rating score to the five statements that assessed the usefulness of the information. Conclusion: This study suggests that prescribers’ knowledge of potential clinically significant DDIs is generally poor. These findings are supported by other research and emphasize the need to develop systems that alert prescribers about potential interactions that are clinically relevant. Physicians most commonly reported learning about potential DDIs from pharmacists, suggesting further work is needed to improve the drug-prescribing process to identify potential safety issues earlier in the medication use process.

Evaluation of Risk Factors and Health Outcomes among Persons with Asthma

Objective: To examine risk factors associated with healthcare utilization in Arizona Medicaid patients with asthma. Methods: Data were obtained from Arizona Medicaid between 1/1/2002 and 12/31/2003. Inclusion criteria consisted of persons with an asthma diagnosis (ICD9-CM 493.XX), 5 to 62 years of age; and were new users of inhaled-corticosteroids (ICS), combination ICS+long-acting beta-agonist, or leukotriene-modifiers. Factors examined included age, geographic location (urban/rural), race/ethnicity (White, non-Hispanic Black, Hispanic, other), medication adherence, pre-period short-acting beta-agonist use (SABA), and co-morbidities. Utilization measures examined included SABA use; exacerbations measured by hospital visits; and asthma-related and total healthcare costs. Analyses for utilization measures were performed using negative binomial, logistic regression, and generalized linear modeling gamma-family, log-link, respectively. Results: A total of 3,013 subjects met inclusion/exclusion criteria and had a mean age (±SD) of 24.7 ±13.7 years. Urban residents were 55% more likely to have an exacerbation than rural residents (odds ratio-OR 0.45, 95%CI: 0.27–0.78). Age (years 18 to 62) was a significant predictor for SABA use (incidence rate ratio-IRR 1.22, 95% CI: 1.06–1.41); and exacerbations (OR 2.07, 95% CI: 1.28–3.38). Mean predicted asthma cost was

IMPACT - Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model

530 (95% CI:

Gender and Age Differences in Medications Dispensed from a National Chain Drugstore

461–608) for ages 5 to 17,

When a Whole Practice Model Is the Intervention: Developing Fidelity Evaluation Components Using Program Theory-Driven Science for an Integrative Medicine Primary Care Clinic

702 (95% CI

Integrative medicine primary care: assessing the practice model through patients’ experiences

600–822) for ages 18 to 39), and

Community Pharmacy Managers' Perception of Computerized Drug—Drug Interaction Alerts

583 (95% CI

Workload and availability of technology in metropolitan community pharmacies.

468–726) for ages 40 to 62. Males were 46% less likely to have an exacerbation than females (OR 0.54, 95% CI: 0.31–0.94). Exacerbations were not different between race/ethnicity categories. Predicted mean asthma-related costs were not different between Whites (

PHP44 PHARMACIST WORKLOAD AND PHARMACY CHARACTERISTICS ASSOCIATED WITH THE DISPENSING OF POTENTIALLY CLINICALLY IMPORTANT DRUG-DRUG INTERACTIONS

591, 95% CI: