(142) Clinically Significant Drug Interaction Alerts in Older Patients, and Related Medically Justified Action

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 816

Presenting Author(s)

Staffan A. Svensson, MD, PhD
– University of Gothenburg, Dept of Pharmacology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden

Co-Author(s)

Carina Tukukino
– Midwife, University of Gothenburg, University of Gothenburg, Gothenburg, V�stra G�talands l�n, Sweden
Naldy Parodi L�pez
– University of Gothenburg, Gothenburg, Sweden
Susanna M. Wallerstedt
– University of Gothenburg, Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, G�teborg, V�stra G�talands l�n, Sweden

Background: Patients are being treated with an increasing number of drugs and this entails a risk of drug-drug interactions. Physicians in Sweden have access to a decision support system that is integrated with the electronic medical record (Janusmed). It is not known to what extent interaction alerts categorised as clinically relevant by this system merit further medical action for the specific patient.

Objective: To investigate the extent to which presented interaction alerts, categorised as clinically relevant, require further medical action for the specific patient.

Methods: We studied interaction alerts provided by Janusmed, presented at physician consultations for 274 consecutive primary care patients, ≥65 years of age and with ≥2 drugs in the medication list. The analysis was retrospective and based on printouts from the medical records for the 2½ years preceding the consultation. Alerts classified as clinically significant (categories C and D according to the Janusmed classification system) were assessed by two specialist physicians, first independently and then in consensus, as to whether they justified any medical action not taken by the prescribing physician.

Results: A total of 206 clinically relevant drug interaction alerts were triggered in 101 (37%) patients. Some action in response to the alert was deemed medically justified for 35 (17%) alerts in 26 (26%) of these patients. The most commonly suggested actions were switching to a less interacting drug in the same drug class (n=10), separating drug intake (n=9), and ordering a laboratory test (n=8). Out of 398 recommendations from the alert system, 38 (10%) were applicable to the specific patient; in most cases, the suggestions had already been satisfactorily addressed, e.g. by monitoring clinical and laboratory parameters or by implementing a separate intake.

Conclusions: One in three older patients in primary care with two or more drugs in the medication list are being treated with drugs that trigger clinically relevant drug interaction alerts. Five in six alerts were already being addressed or were not relevant in the clinical setting. These findings may suggest that the alert system has had the intended effect of affecting physician behaviour, but also illustrate the risk of information overload and alert fatigue.