| DOI: DOI:10.29090/psa.2024.04.24.AP0710 | Pharm Sci Asia 2024; 51(4), 360-368 |
Enhancing Medication Safety: How Clinical Decision Support Systems and Clinical Pharmacists’ Interventions Address Drug-Disease InteractionsNguyen Thi Hong Hanh1, Vu Duong Anh Minh1, Le Trong Hieu1, Tran Thi Thu Thuy4,Vu Hoai Huong Giang1, Tran Thu Phuong1, Nguyen Thi Hanh2, Hoang Thanh Tuyen2, Christine Cadiz3, Nguyen Thanh Hai1,*
1 Department of Clinical Pharmacy, Faculty of Pharmacology and Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
2
19-8 Hospital, Ministry of Public Security, Hanoi, Vietnam
3
School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, California, USA
4
Department of Pharmacy, Saint Paul General Hospital, Hanoi, Vietnam
Drug-disease interactions (DDSIs) occur when a medicine aimed at treating one disease may worsen another comorbidity or condition. Clinical decision support systems (CDSS) to screen DDSIs have been demonstrated to be an effective and labor-saving method, while clinical pharmacist interventions help manage clinically relevant interactions. Incorporating both CDSS and clinical pharmacist interventions may serve as a good practice model to further improve DDSI management. This study aims to assess the impact of the CDSS and clinical pharmacist interventions in mitigating DDSI. A quasi-experimental study was conducted to compare the prevalence of DDSIs before and after the application of CDSS and clinical pharmacist interventions. The CDSS was developed by integrating a DDSIs database into the hospital software systems. The database was built by a multidisciplinary team based on thorough literature screening and discussions with healthcare experts. It included interaction pairs (medicine code – ICD-10 code) with their severity, details on clinical outcomes, and management strategies. The CDSS started to provide alerts for physicians in December 2022. In cases where the physicians ignore the alerts, clinical pharmacists are involved in consultation. A total of 139,136 and 150,934 prescriptions were included during the pre- and post-interventional periods, respectively. After interventions, there was a significant reduction in the prevalence of total DDSIs, from 0.14% (95% CI: 0.12% - 0.17%) in the pre-intervention phase to 0.015% (95% CI: 0.010% - 0.022%) in the post-interventional phase, with an odds ratio of 0.1 (95% CI: 0.07 – 0.16). The rate of contraindicated interactions decreased from 0.06% to 0.005% (OR: 0.08; 95%CI: 0.04 – 0.17), and major interactions were reduced from 0.08% to 0.009% (OR: 0.11; 95%CI: 0.07-0.20). In the post-intervention period, a continuous decrease in the number of interactions was also noted over 3 months. The utilization of CDSS for identifying drug-disease interactions and clinical pharmacist interventions have been shown to reduce the prevalence of DDSIs, thereby improving medication safety.
Keyword:
Drug Disease Interaction; Clinical Decision Support System; Clinical Pharmacist
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