Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal
Main Article Content
Keywords
Drug Interactions, Inpatients, Education, Continuing, Nepal
Abstract
Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs).
Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses.
Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of ‘Moderate’ type and 58% had a ‘Delayed’ onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a ‘Good’ documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during pre-intervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention).
Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy.
References
2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. J Am Med Assoc. 2003;289:2560-2572.
3. Boston Collaborative Drug Survelliance Program: Adverse drug interactions. J Am Med Assoc. 1972;220:1238-1239.
4. Classen DC, Pestotnick SL, Evans RS, Bukke JP. Computerized surveillance of adverse drug events in hospital patients. J Am Med Assoc. 1991;266:2847-2851.
5. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR. Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc. 1988;36:1092-1098.
6. Stockley IH. Drug interaction: a source book of adverse interaction, their mechanisms, clinical importance and management.5th ed. Pharmaceutical Press, London 1999.
7. Smith JW, Seild L G, Cluff L E. Studies on the epidemiology of adverse drug reactions. V. Clinical factors influencing susceptibility. Ann Intern Med. 1969;65:629.
8. Joshi MP, Sugimoto T, Santoso B. Geriatric prescribing in the medical wards of a teaching hospital in Nepal. Pharmacoepidemiol Drug Saf. 1997;6:417-421.
9. Thomson Micromedex, Greenwood Village, Colorado (Edition expires [6/2006])
10. Jankel CA, Fitterman LK. Epidemiology of drug-drug interactions as a cause of hospital admissions. Drug Saf. 1993;9:55-59.
11. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377-384.
12. Merlo J, Liedholm H, Lindblad U, Björck-Linné A, Fält J, Lindberg G, Melander A. Prescriptions with potential drug interactions dispensed at Swedish pharmacies in January 1999: cross sectional study. BMJ. 2001;323:427-428.
13. Nagavi BG, Singhal R. Drug interactions in prescription from selected Indian community pharmacies. J Pharm Pract Res. 2005;35:332.
14. Bergendal L, Friberg A, Schaffrath AM. Potential drug-drug interactions in 5,125 mostly elderly out-patients in Gothenburg, Sweden. Pharm World Sci. 1995;17:152-157.
15. Stewart RB, Cooper JW. Polypharmacy in the aged. Practical solutions. Drugs Aging. 1994;4:449-461.
16. Biorkman IK, Fastbom J, Schmidt IK, Bernsten CB. Drug-drug interactions in the elderly. Ann Pharmacother. 2002;36:1675-1681.
17. Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med. 1996;14;447-450.
18. Egger SS, Drewe J, Schlienger RG. Potential drug-drug interactions in the medication of medical patients at hospital discharge. Eur J Clin Pharmacol. 2003; 58:773-778.
19. Oeser DE, Polansky M, Thomas NP, Varon J. Incidence of major drug interactions and associated adverse drug events in a surgical intensive care unit. Internet J Pharmacol. 2003;2.
20. Johnson MD, Newkirk G, White JR Jr. Clinically significant drug interactions: what you need to know before writing prescriptions. Postgrad Med. 1999;105:193-206.
21. Chadwick B, Waller DG, Edwards JG. Potentially hazardous drug interactions with psychotropics. Advances in Psychiatric treatment. 2005;11:440-449.
22. Hussar DA. Drug interaction. In: Gennaro, Marderosian AHD, Hanson GR et al. Remington The science and practice of pharmacy. Philadelphia: Lippincott Williams & Wilkins, 2000: 1746-1761.
23. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329:15-19.
24. Doucet J, Chassagne P, Trivalle C, Landrin I, Pauty MD, Kadri N, Ménard JF, Bercoff E. Drug-drug interactions related to hospital admissions in older adults: a prospective study of 1000 patients. J Am Geriatr Soc. 1996;44:944-948.
25. Durrence CW 3rd, DiPiro JT, May JR, Nesbit RR Jr, Sisley JF, Cooper JW. Potential drug interactions in surgical patients. Am J Hosp Pharm. 1985;42:1553-1556.