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Erschienen in: International Journal of Clinical Pharmacy 3/2017

01.06.2017 | Research Article

A survey of attitudes, practices, and knowledge regarding drug–drug interactions among medical residents in Iran

verfasst von: Ehsan Nabovati, Hasan Vakili-Arki, Zhila Taherzadeh, Mohammad Reza Saberi, Ameen Abu-Hanna, Saeid Eslami

Erschienen in: International Journal of Clinical Pharmacy | Ausgabe 3/2017

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Abstract

Background When prescribing medications, physicians should recognize clinically relevant potential drug–drug interactions (DDIs). To improve medication safety, it is important to understand prescribers’ knowledge and opinions pertaining to DDIs. Objective To determine the current DDI information sources used by medical residents, their knowledge of DDIs, their opinions about performance feedback on co-prescription of interacting drugs. Setting Academic hospitals of Mashhad University of Medical Sciences (MUMS) in Iran. Methods A questionnaire containing questions regarding demographic and practice characteristics, DDI information sources, ability to recognize DDIs, and opinions about performance feedback was distributed to medical residents of 22 specialties in eight academic hospitals in Iran. We analyzed their perception pertaining to DDIs, their performance on classifying drug pairs, and we used a linear regression model to assess the association of potential determinants on their DDI knowledge. Main Outcome Measure prescribers’ knowledge and opinions pertaining to DDIs. Results The overall response rate and completion rate for 315 distributed questionnaires were 90% (n = 295) and 86% (n = 281), respectively. Among DDI information sources, books, software on mobile phone or tablet, and Internet were the most commonly-used references. Residents could correctly classify only 41% (5.7/14) of the drug pairs. The regression model showed no significant association between residents’ characteristics and their DDI knowledge. An overwhelming majority of the respondents (n = 268, 95.4%) wished to receive performance feedback on co-prescription of interacting drugs in their prescriptions. They mostly selected information technology-based tools (i.e. short text message and email) as their preferred method of receiving feedback. Conclusion Our findings indicate that prescribers may have poor ability to prevent clinically relevant potential DDI occurrence, and they perceive the need for performance feedback. These findings underline the importance of well-designed computerized alerting systems and delivering performance feedback to improve patient safety.
Literatur
1.
Zurück zum Zitat Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.CrossRefPubMed Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.CrossRefPubMed
2.
Zurück zum Zitat Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23:489–97.CrossRefPubMed Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23:489–97.CrossRefPubMed
3.
Zurück zum Zitat Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–8.CrossRefPubMed Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–8.CrossRefPubMed
4.
Zurück zum Zitat Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician’s expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg. 2014;69:157–64.CrossRefPubMed Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician’s expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg. 2014;69:157–64.CrossRefPubMed
5.
Zurück zum Zitat Malone DC, Liberman JN, Sun D. Effect of an educational outreach program on prescribing potential drug–drug interactions. J Managed Care Pharm. 2013;19:549–57.CrossRef Malone DC, Liberman JN, Sun D. Effect of an educational outreach program on prescribing potential drug–drug interactions. J Managed Care Pharm. 2013;19:549–57.CrossRef
6.
Zurück zum Zitat Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract. 2009;7:242–7. Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract. 2009;7:242–7.
7.
Zurück zum Zitat Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug–drug interaction database SFINX on prevalence of potentially serious drug–drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69:565–71.CrossRefPubMed Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug–drug interaction database SFINX on prevalence of potentially serious drug–drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69:565–71.CrossRefPubMed
8.
Zurück zum Zitat Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166:1009–15.CrossRefPubMed Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166:1009–15.CrossRefPubMed
9.
Zurück zum Zitat Strom BL, Schinnar R, Bilker W, Hennessy S, Leonard CE, Pifer E. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID-warfarin co-prescribing as a test case. J Am Med Inform Assoc JAMIA. 2010;17:411–5.CrossRefPubMed Strom BL, Schinnar R, Bilker W, Hennessy S, Leonard CE, Pifer E. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID-warfarin co-prescribing as a test case. J Am Med Inform Assoc JAMIA. 2010;17:411–5.CrossRefPubMed
10.
Zurück zum Zitat Armstrong EP, Wang SM, Hines LE, Gao S, Patel BV, Malone DC. Evaluation of a drug–drug interaction: fax alert intervention program. BMC Med Inform Decis Mak. 2013;13:32.CrossRefPubMedPubMedCentral Armstrong EP, Wang SM, Hines LE, Gao S, Patel BV, Malone DC. Evaluation of a drug–drug interaction: fax alert intervention program. BMC Med Inform Decis Mak. 2013;13:32.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Glassman PA, Belperio P, Lanto A, Simon B, Valuck R, Sayers J, et al. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. J Am Med Inform Assoc JAMIA. 2007;14:424–31.CrossRefPubMed Glassman PA, Belperio P, Lanto A, Simon B, Valuck R, Sayers J, et al. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. J Am Med Inform Assoc JAMIA. 2007;14:424–31.CrossRefPubMed
12.
Zurück zum Zitat Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.CrossRefPubMed Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.CrossRefPubMed
13.
Zurück zum Zitat Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care. Am J Med Qual. 2011;26:145–53.CrossRefPubMed Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care. Am J Med Qual. 2011;26:145–53.CrossRefPubMed
14.
Zurück zum Zitat Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.CrossRefPubMed Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.CrossRefPubMed
15.
Zurück zum Zitat Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE, Abarca J, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31:525–36.CrossRefPubMed Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE, Abarca J, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31:525–36.CrossRefPubMed
16.
Zurück zum Zitat Hincapie AL, Warholak TL, Hines LE, Taylor AM, Malone DC. Impact of a drug–drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: a 1-year follow-up. Res Soc Adm Pharm RSAP. 2012;8:472–7.CrossRef Hincapie AL, Warholak TL, Hines LE, Taylor AM, Malone DC. Impact of a drug–drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: a 1-year follow-up. Res Soc Adm Pharm RSAP. 2012;8:472–7.CrossRef
17.
Zurück zum Zitat Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug–drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU. 2014;22:52.CrossRefPubMedPubMedCentral Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug–drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU. 2014;22:52.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30:607–10.CrossRef Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30:607–10.CrossRef
19.
Zurück zum Zitat Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27:94–104.CrossRef Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27:94–104.CrossRef
20.
Zurück zum Zitat Warholak TL, Menke JM, Hines LE, Murphy JE, Reel S, Malone DC. A drug–drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence. Res Soc Adm Pharm RSAP. 2011;7:16–26.CrossRef Warholak TL, Menke JM, Hines LE, Murphy JE, Reel S, Malone DC. A drug–drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence. Res Soc Adm Pharm RSAP. 2011;7:16–26.CrossRef
21.
Zurück zum Zitat Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994. Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
22.
Zurück zum Zitat Budtz-Jorgensen E, Keiding N, Grandjean P, Weihe P. Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol. 2007;17:27–35.CrossRefPubMed Budtz-Jorgensen E, Keiding N, Grandjean P, Weihe P. Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol. 2007;17:27–35.CrossRefPubMed
23.
Zurück zum Zitat Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A, et al. Practitioners’ views on computerized drug–drug interaction alerts in the VA system. J Am Med Inform Assoc JAMIA. 2007;14:56–64.CrossRefPubMed Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A, et al. Practitioners’ views on computerized drug–drug interaction alerts in the VA system. J Am Med Inform Assoc JAMIA. 2007;14:56–64.CrossRefPubMed
24.
Zurück zum Zitat Abbasi Nazari M, Salamzadeh J, Hajebi G, Gilbert B. The role of clinical pharmacists in educating nurses to reduce drug–food interactions (absorption phase) in hospitalized patients. Iran J Pharm Res IJPR. 2011;10:173–7.PubMed Abbasi Nazari M, Salamzadeh J, Hajebi G, Gilbert B. The role of clinical pharmacists in educating nurses to reduce drug–food interactions (absorption phase) in hospitalized patients. Iran J Pharm Res IJPR. 2011;10:173–7.PubMed
25.
Zurück zum Zitat Abbasinazari M, Hajhossein Talasaz A, Eshraghi A, Sahraei Z. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica. 2013;51:482–6.PubMed Abbasinazari M, Hajhossein Talasaz A, Eshraghi A, Sahraei Z. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica. 2013;51:482–6.PubMed
26.
Zurück zum Zitat Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm. 2011;33:281–4.CrossRefPubMed Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm. 2011;33:281–4.CrossRefPubMed
27.
Zurück zum Zitat Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S. Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. Eur J Intern Med. 2013;24:227–33.CrossRefPubMed Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S. Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. Eur J Intern Med. 2013;24:227–33.CrossRefPubMed
28.
Zurück zum Zitat Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26:423–36.CrossRefPubMed Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26:423–36.CrossRefPubMed
29.
Zurück zum Zitat Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nursing. 2006;27:118–29.CrossRef Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nursing. 2006;27:118–29.CrossRef
30.
Zurück zum Zitat Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population. Eur J Clin Pharmacol. 2000;56:495–9.CrossRefPubMed Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population. Eur J Clin Pharmacol. 2000;56:495–9.CrossRefPubMed
31.
Zurück zum Zitat Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.CrossRefPubMedPubMedCentral Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging. 2014;31:527–40.CrossRefPubMed Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging. 2014;31:527–40.CrossRefPubMed
33.
Zurück zum Zitat Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, et al. Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. J Am Pharm Assoc JAPhA. 2004;44:142–51.CrossRef Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, et al. Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. J Am Pharm Assoc JAPhA. 2004;44:142–51.CrossRef
34.
Zurück zum Zitat Olson KE, O’Brien MA, Rogers WA, Charness N. Diffusion of technology: frequency of use for younger and older adults. Ageing Int. 2011;36:123–45.CrossRefPubMedPubMedCentral Olson KE, O’Brien MA, Rogers WA, Charness N. Diffusion of technology: frequency of use for younger and older adults. Ageing Int. 2011;36:123–45.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Ko Y, Malone DC, D’Agostino JV, Skrepnek GH, Armstrong EP, Brown M, et al. Potential determinants of prescribers’ drug–drug interaction knowledge. Res Soc Adm Pharm RSAP. 2008;4:355–66.CrossRef Ko Y, Malone DC, D’Agostino JV, Skrepnek GH, Armstrong EP, Brown M, et al. Potential determinants of prescribers’ drug–drug interaction knowledge. Res Soc Adm Pharm RSAP. 2008;4:355–66.CrossRef
36.
Zurück zum Zitat Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharm. 2011;9:364–77.CrossRef Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharm. 2011;9:364–77.CrossRef
37.
Zurück zum Zitat Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm. 2016;38:1052–6.CrossRefPubMed Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm. 2016;38:1052–6.CrossRefPubMed
38.
Zurück zum Zitat Nabovati E, Vakili-Arki H, Taherzadeh Z, Saberi MR, Abu-Hanna A, Eslami S. Incidence rate and pattern of clinically relevant potential drug–drug interactions in a large outpatient population of a developing country. Res Pharm Sci. 2016;11:233–42.PubMedPubMedCentral Nabovati E, Vakili-Arki H, Taherzadeh Z, Saberi MR, Abu-Hanna A, Eslami S. Incidence rate and pattern of clinically relevant potential drug–drug interactions in a large outpatient population of a developing country. Res Pharm Sci. 2016;11:233–42.PubMedPubMedCentral
39.
Zurück zum Zitat Stoll P, Kopittke L. Potential drug–drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm. 2015;37:475–84.CrossRefPubMed Stoll P, Kopittke L. Potential drug–drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm. 2015;37:475–84.CrossRefPubMed
Metadaten
Titel
A survey of attitudes, practices, and knowledge regarding drug–drug interactions among medical residents in Iran
verfasst von
Ehsan Nabovati
Hasan Vakili-Arki
Zhila Taherzadeh
Mohammad Reza Saberi
Ameen Abu-Hanna
Saeid Eslami
Publikationsdatum
01.06.2017
Verlag
Springer International Publishing
Erschienen in
International Journal of Clinical Pharmacy / Ausgabe 3/2017
Print ISSN: 2210-7703
Elektronische ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-017-0453-3

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