Drug interactions in healthcare - Knowledge resources and clinical management
Abstract
Background and aim: Many patients are treated with several drugs concomitantly, implying a risk of drug interactions. The clinical consequences of drug interactions depend not only on the drugs, but also on patient characteristics. To gain specific information on drug interactions, healthcare professionals in Sweden can access a Swedish national interaction knowledge resource (Janusmed) and/or regional drug information centres. The aims of this thesis were to explore these knowledge resources regarding drug interactions and to investigate the clinical management of potentially problematic drug interactions.
Methods and results: In study I, 159 (27%) out of 589 replies from a drug information centre, regarding queries on drug interactions over a 10-year period, included advice to avoid concurrent use, to adjust doses, or to separate the intake. In all, 113 (71%) of these queries would have been alerted in Janusmed as clinically significant drug interactions. Study II included 109 drug pairs, encountered in study III, that triggered a clinically significant interaction alert in Janusmed. Comparing classifications according to Janusmed with three other interaction alert systems, it appeared that between 41% and 82% of the drug pairs were similarly classified in the other resources. The provided recommendations for clinical management were entirely similar for 8% to 19% of the drug pairs, and partly similar for 74% to 86%. Study III concerned 405 drug interaction alerts that were triggered by the medication lists of 274 older patients in primary care and classified with varying clinical significance. When assessed by two specialist physicians in consensus, taking individual circumstances into account, a total of 35 (9%) alerts merited a related action. In study IV, questionnaire results from 124 physicians regarding a fictional patient case showed that interaction alert-related actions differed somewhat between residents in family medicine and hospital interns. Furthermore, the classification of interaction alerts was associated with the physicians’ decision to access the detailed information provided by Janusmed.
Conclusions: Advice provided by drug information centres and drug interaction knowledge resources is often similar but there are non-negligible differences, and the same applies to a comparison between well-renowned interaction alert systems. Most automated drug interaction alerts, however, do not merit action when the situation of the specific patient is considered. Physicians’ reported actions seem to be guided by the alert classifications and advice provided by the resource.
Parts of work
I. Tukukino C, Wallerstedt SM. Drug information centre queries and responses about drug interactions over 10 years—A descriptive analysis. Basic Clin Pharmacol Toxicol. 2019;126(1):65-74. http://doi.org/10.1111/bcpt.13294 II. Tukukino C, Eriksson AL, Hamdan W, Wallin Hybelius F, Wallerstedt SM. Interaction alerts: A comparison of classifications and recommendations for clinical management between Janusmed and three other knowledge resources. Basic Clin Pharmacol Toxicol. 2023;1‐13. http://doi.org/10.1111/bcpt.13843 III.Tukukino C, Parodi López N, Svensson SA, Wallerstedt SM. Drug interaction alerts in older primary care patients and related medically justified actions. Eur J Clin Pharmacol. 2022;78(7):1115-1126. http://doi.org/10.1007/s00228-022-03292-4 IV. Tukukino C, Parodi López N, Lönnbro J, Wallerstedt SM, Svensson SA. Pharmacotherapeutic actions related to drug interaction alerts ₋ a questionnaire study among Swedish hospital interns and residents in family medicine. Eur J Clin Pharmacol. 2024. Accepted
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Neuroscience and Physiology. Department of Pharmacology
Disputation
Torsdagen den 6 februari 2025, kl 13.00,Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3, Göteborg
Date of defence
2025-02-06
carina.tukukino@gu.se
Date
2025-01-14Author
Tukukino, Carina
Keywords
classification
clinical management
drug information centre
drug-drug interaction
interaction knowledge resources
older people
pharmacotherapeutic actions
physicians
primary care
questionnaire
Publication type
Doctoral thesis
ISBN
978-91-8069-967-9 (PRINT)
978-91-8069-968-6 (PDF)
Language
eng