Management of drug interactions with beta-blockers: continuing education has a short-term impact

Main Article Content

Annelies Driesen
Steven Simoens
Gert Laekeman

Keywords

Drug Interactions, Continuing education, Pharmacy, Pharmacists, Belgium

Abstract

There is a lack of clear guidelines regarding the management of drug-drug interactions.

Objective: To assess the impact of an educational intervention on the management of drug interactions with beta-blockers.

Methods: The study had a controlled before-and-after design. The intervention group (n=10 pharmacies) received a continuing education course and guidelines on the management of drug interactions with beta-blockers. The control group (n=10 pharmacies) received no intervention. Pharmacy students and staff of internship pharmacies participated in this study. Before and after the intervention, students registered interactions with beta-blockers during two weeks. Information was obtained on drug information of the beta-blocker and the interacting drug, patient’s demographics, and the mode of transaction.

Results: A total number of 288 interactions were detected during both study periods. Most beta-blockers causing an interaction were prescribed for hypertension, and interacted with hypoglycemic agents, NSAIDs, or beta2-agonists. Pharmacists’ intervention rate was low (14% in the pre-test compared to 39% in the post-test), but increased significantly in the post-test in the intervention group. Reasons for overriding the interaction included limited clinical relevance, refill prescriptions, not being aware of the interaction, and communication problems with the prescriber.

Conclusion: An interactive continuing education course, during which practice-oriented guidelines were offered, affected pharmacists’ short-term behavior at the counter in dealing with interactions of beta-blockers. Continuing education plays a role in raising pharmacists’ awareness and responsibility towards the detection and management of drug interactions in the pharmacy.

Abstract 1392 | PDF Downloads 748

References

1. Pharmaceutical Care Network Europe Foundation. PCNE Classification for drug related problems. http://www.pcne.org/dokumenter/PCNE%20classification%20V5.00.pdf (accessed April 19, 2006).

2. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004;329:15-9.

3. Royal S, Smeaton L, Avery AJ et al. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care 2006;15:23-31.

4. Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care 1992;30:926-40.

5. Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of intervention of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25:65-9.

6. Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H; ESCP-SIR Rejkjavik Community Pharmacy Research Group. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci 2004;26:353-60.

7. Currie JD, Chrischilles EA, Kuehl AK, Buser RA. Effect of a training program on community pharmacists' detection of and intervention in drug-related problems. J Am Pharm Assoc 1997;NS37:182-91.

8. Hansten PD. Drug interaction management. Pharm World Sci 2003;25:94-7.

9. Leemans L, Laekeman G. Computer-assisted drug delivery in community pharmacies: pharmaco-epidemiological and scientific consequences. J Soc Admin Pharm 1994;11:131-8.

10. Bates DW, Leape LL. Pharmacies and prevention of potentially fatal drug interactions. JAMA 1996;275:1086-7.

11. McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976;295:1351-5.

12. Westerlund T, Almarsdóttir AB, Melander A. Factors influencing the detection rate of drug-related problems in community pharmacy. Pharm World Sci 1999;21:245-50.

13. Leape LL, Bates DW, Cullen DJ. Systems analysis of adverse drug events. JAMA 1995;274:35-43.

14. Cavuto JC, Woosley RL, Sale M. Pharmacies and prevention of potentially fatal drug interactions. JAMA 1996;275:1086.

15. Heikkilä T, Lekander T, Raunio H. Use of an online surveillance system for screening drug interactions in prescriptions in community pharmacies. Eur J Clin Pharmacol 2006;62(8):661-5.

16. Murphy JE, Forrey RA, Desiraju U. Community pharmacists' responses to drug-drug interaction alerts. Am J Health-Syst Pharm 2004;61:1484-7.

17. Fulda TR, Valuck RJ, Vander Zanden J et al. Disagreement among drug compendia on inclusion and ratings of drug-drug interactions. Curr Ther Res Clin Exp 2000;61:540-8.

18. Hansten PD, Horn JR. Drug interaction analysis and management. Facts and Comparisons. St. Louis, MO; 2001.

19. Stockley IH. Stockley's drug interactions. 6th ed. London: The Pharmaceutical Press; 2002.

20. Anonymus. Commentaren medicatiebewaking [Drug monitoring]. 18th ed. Houten: Stichting Health Base; 2003.

21. Shah SNH, Aslam M, Avery AJ. A survey of prescription errors in general practice. Pharm J 2001;267:860-2.

22. Tanskanen P, Airaksinen M, Tanskanen A, Enlund H. Counselling patients on psychotropic medication: physicians' opinion on the role of community pharmacists. Pharm World Sci. 2000;22:59-61.

23. Office of evaluation and inspections. The clinical role of the community pharmacist. Washington, DC: US Department of Health and Human Services, 1990; publication no. OEI-01-89-89161.

24. Horn JR, Hansten PD. Computerized drug-interaction alerts: is anybody paying attention? Pharm Times [serial online]. 2004 February.

25. Horn JR, Hansten PD. Sources of error in drug interactions: the Swiss cheese model. Pharm Times [serial online]. 2004 March.

26. Magnus D, Rodgers S, Avery AJ. GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002;27:377-82.

27. Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians' decisions to override computerized drug alerts in primary care. Arch Intern Med 2003;163:2625-31.

28. Spina JR, Glassman PA, Belperio P, Cader R, Asch S; Primary Care Investigative Group of the VA Los Angeles Healthcare System. Clinical relevance of automated drug alerts from the perspective of medical providers. Am J Med Qual 2005;20:7-14.

29. Becker ML, Kallewaard M, Caspers PW, Schalekamp T, Stricker BH. Potential determinants of drug-drug interaction associated dispensing in community pharmacies. Drug Saf 2005;28:371-8.

30. Vinks TH, de Koning FH, de Lange TM, Egberts TC. Identification of potential drug-related problems in the elderly: the role of the community pharmacist. Pharm World Sci. 2006;28(1):33-8.

31. Thomson O'Brien MA, Freemantle N, Oxman AD et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews. 2001; Art. No. CD003030. DOI: 10.1002/14651858.

32. Fjortoft NF, Schwartz AH. Evaluation of a pharmacy continuing education program: long-term learning outcomes and changes in practice behaviors. Am J Pharm Educ. 2003; 67: article 35.

33. Kansanaho H, Pietilä K, Airaksinen M. Can a long-term continuing education course in patient counseling promote a change in the practice of Finnish community pharmacists? Int J Pharm Pract 2003;11:153-60.

34. de Almeida Neto AC, Benrimoj SI, Kavanagh DJ, Boakes RA. Novel educational training program for community pharmacists. Am J Pharm Educ 2000;64:302-7.