Cargando…
The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies
INTRODUCTION: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was con...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907715/ https://www.ncbi.nlm.nih.gov/pubmed/33708374 http://dx.doi.org/10.1177/2042098621996098 |
_version_ | 1783655554533556224 |
---|---|
author | Berger, Florine A. van der Sijs, Heleen van Gelder, Teun van den Bemt, Patricia M. L. A. |
author_facet | Berger, Florine A. van der Sijs, Heleen van Gelder, Teun van den Bemt, Patricia M. L. A. |
author_sort | Berger, Florine A. |
collection | PubMed |
description | INTRODUCTION: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. METHODS: An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome. RESULTS: Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49–1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool. CONCLUSION: The CDS tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts. PLAIN LANGUAGE SUMMARY: The use of a tool to support the handling of QTc-prolonging drug interactions in community pharmacies Introduction: Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug–drug interactions (QT-DDIs). Methods: In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Results: Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. Conclusion: The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. |
format | Online Article Text |
id | pubmed-7907715 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79077152021-03-10 The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies Berger, Florine A. van der Sijs, Heleen van Gelder, Teun van den Bemt, Patricia M. L. A. Ther Adv Drug Saf Original Research INTRODUCTION: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. METHODS: An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome. RESULTS: Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49–1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool. CONCLUSION: The CDS tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts. PLAIN LANGUAGE SUMMARY: The use of a tool to support the handling of QTc-prolonging drug interactions in community pharmacies Introduction: Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug–drug interactions (QT-DDIs). Methods: In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Results: Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. Conclusion: The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. SAGE Publications 2021-02-24 /pmc/articles/PMC7907715/ /pubmed/33708374 http://dx.doi.org/10.1177/2042098621996098 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Berger, Florine A. van der Sijs, Heleen van Gelder, Teun van den Bemt, Patricia M. L. A. The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title | The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title_full | The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title_fullStr | The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title_full_unstemmed | The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title_short | The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies |
title_sort | use of a clinical decision support tool to assess the risk of qt drug–drug interactions in community pharmacies |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907715/ https://www.ncbi.nlm.nih.gov/pubmed/33708374 http://dx.doi.org/10.1177/2042098621996098 |
work_keys_str_mv | AT bergerflorinea theuseofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vandersijsheleen theuseofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vangelderteun theuseofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vandenbemtpatriciamla theuseofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT bergerflorinea useofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vandersijsheleen useofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vangelderteun useofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies AT vandenbemtpatriciamla useofaclinicaldecisionsupporttooltoassesstheriskofqtdrugdruginteractionsincommunitypharmacies |