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1.  Evaluation of a drug-drug interaction: fax alert intervention program 
Background
Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.
Methods
A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.
Results
A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p = 0.177).
Conclusions
This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.
doi:10.1186/1472-6947-13-32
PMCID: PMC3598564  PMID: 23497373
Drug interactions; Drug safety; Physician; Prescriber; Fax
2.  Pharmacy Students' Ability to Identify Potential Drug-Drug Interactions 
Objective
To evaluate the ability of third- and fourth-year pharmacy students to identify clinically significant drug-drug interactions (DDIs)
Methods
A questionnaire designed to measure DDI knowledge was disseminated to fourth-year pharmacy students in a school of pharmacy. A second questionnaire was distributed to third-year pharmacy students in 2 schools of pharmacy (schools A and B) and re-administered to students in 1 of the schools 1 year later.
Results
Class of 2005 fourth-year pharmacy students correctly categorized an average of 52% ± 13% DDI pairs on the first questionnaire. Third-year pharmacy students at schools A and B correctly categorized an average of 61% ± 18% and 66% ± 15% of DDI pairs, respectively. The average percentage of correct responses for fourth-year students from the class of 2007 was 65% (± 17%).
Conclusion
Pharmacy students' ability to identify important DDIs is far from optimal, even after completing experiential requirements.
PMCID: PMC2690898  PMID: 19513165
drug interaction
3.  Physicians' opinions of a health information exchange 
Background
Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE).
Objective
To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs.
Measurements
A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding.
Results
A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of “doctor shopping”; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system.
Conclusion
Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.
doi:10.1136/jamia.2010.006502
PMCID: PMC3005874  PMID: 21106994
4.  Ability of pharmacy clinical decision-support software to alert users about clinically important drug–drug interactions 
Objective
Pharmacy clinical decision-support (CDS) software that contains drug–drug interaction (DDI) information may augment pharmacists' ability to detect clinically significant interactions. However, studies indicate these systems may miss some important interactions. The purpose of this study was to assess the performance of pharmacy CDS programs to detect clinically important DDIs.
Design
Researchers made on-site visits to 64 participating Arizona pharmacies between December 2008 and November 2009 to analyze the ability of pharmacy information systems and associated CDS to detect DDIs. Software evaluation was conducted to determine whether DDI alerts arose from prescription orders entered into the pharmacy computer systems for a standardized fictitious patient. The fictitious patient's orders consisted of 18 different medications including 19 drug pairs—13 of which were clinically significant DDIs, and six were non-interacting drug pairs.
Measurements
The sensitivity, specificity, positive predictive value, negative predictive value, and percentage of correct responses were measured for each of the pharmacy CDS systems.
Results
Only 18 (28%) of the 64 pharmacies correctly identified eligible interactions and non-interactions. The median percentage of correct DDI responses was 89% (range 47–100%) for participating pharmacies. The median sensitivity to detect well-established interactions was 0.85 (range 0.23–1.0); median specificity was 1.0 (range 0.83–1.0); median positive predictive value was 1.0 (range 0.88–1.0); and median negative predictive value was 0.75 (range 0.38–1.0).
Conclusions
These study results indicate that many pharmacy clinical decision-support systems perform less than optimally with respect to identifying well-known, clinically relevant interactions. Comprehensive system improvements regarding the manner in which pharmacy information systems identify potential DDIs are warranted.
doi:10.1136/jamia.2010.007609
PMCID: PMC3005877  PMID: 21131607
5.  Healthcare Professional Students’ Knowledge of Drug-Drug Interactions 
Objectives. To evaluate changes in medical, pharmacy, and nurse practitioner students’ drug-drug interaction (DDI) knowledge after attending an educational program.
Design. A DDI knowledge assessment containing 15 different drug pairs was administered to participants before and after a 45-minute educational session.
Evaluation. Pharmacy, medical, and nursing students scored significantly higher on the posttest assessment for DDI recognition (median change 3, 9, and 8, respectively) and management strategy (median change 5, 9, 8, respectively), indicating a significant improvement in DDI knowledge as a result of the educational session. Pharmacy students scored significantly higher on the pretest; however, no difference was observed between the students’ posttest scores. Posttest scores for all student groups were significantly greater than their respective pretest scores (p < 0.001).
Conclusions. Significant improvement in healthcare professional students’ DDI knowledge was observed following participation in the educational session.
doi:10.5688/ajpe7510199
PMCID: PMC3279016  PMID: 22345718
drug-drug interaction; drug interaction knowledge; medical education; pharmacy education; nurse practitioner education
6.  Science of Safety Topic Coverage in Experiential Education in US and Taiwan Colleges and Schools of Pharmacy 
Objective. To compare the science of safety (SoS) topic coverage and associated student competencies in the experiential education curricula of colleges and schools of pharmacy in the United States and Taiwan.
Methods. The experiential education director, assistant director, or coordinator at a random sample of 34 US colleges and schools of pharmacy and all 7 Taiwan schools of pharmacy were interviewed and then asked to complete an Internet-based survey instrument.
Results. Faculty members in both countries perceived that experiential curricula were focused on the postmarketing phase of the SoS, and that there is a need for the pharmacy experiential curricula to be standardized in order to fill SoS coverage gaps. Inter-country differences in experiential SoS coverage were noted in topics included for safety biomarkers that signal potential for drug-induced problems and pharmacogenomics.
Conclusions. Experiential SoS topic coverage and student ability gaps were perceived within and between US and Taiwan colleges and schools of pharmacy.
doi:10.5688/ajpe7510202
PMCID: PMC3279028  PMID: 22345721
science of safety; experiential education; survey research; international
7.  The Science of Safety Curriculum in US Colleges and Schools of Pharmacy 
Objective. To describe the integration of science of safety (SoS) topics in doctor of pharmacy (PharmD) curricula of US colleges and schools of pharmacy.
Methods. A questionnaire that contained items pertaining to what and how SoS topics are taught in PharmD curricula was e-mailed to representatives at 107 US colleges and schools of pharmacy.
Results. The majority of the colleges and schools responding indicated that they had integrated SoS topics into their curriculum, however, some gaps (eg, teaching students about communicating risk, Food and Drug Administration [FDA] Sentinel Initiative, utilizing patient databases) were identified that need to be addressed.
Conclusions. The FDA and the American Association of Colleges of Pharmacy (AACP) should continue to collaborate to develop resources needed to ensure that topics proposed by the FDA in their SoS framework are taught at all colleges and schools of pharmacy.
doi:10.5688/ajpe757141
PMCID: PMC3175655  PMID: 21969727
medication safety; pharmacy education; curriculum; science of safety
8.  Perspectives on Educating Pharmacy Students About the Science of Safety 
Objective. To identify opinions about pharmacy graduates’ science of safety (SoS) educational needs.
Methods. Semi-structured interviews were performed with 25 educators and researchers at US pharmacy colleges and schools and 5 individuals from associations engaged in drug safety-related issues.
Results. Themes that emerged from the 30 interviews with key informants included: pharmacists should meet minimum SoS requirements; medication safety education is inconsistent; and barriers exist to improving SoS curricula. Student deficiencies noted included the lack of: student acceptance of a “culture of safety”: ability to effectively communicate verbally about medication safety; knowledge of the drug development process; and quality improvement skills. Key informants did not agree on how to address these gaps.
Conclusions. While educators, researchers, and other leaders in drug safety-related issues thought that US colleges and schools of pharmacy covered portions of SoS well, there were perceived deficiencies. Minimum standards should be set to assist with curricular adoption of SoS.
doi:10.5688/ajpe757142
PMCID: PMC3175660  PMID: 21969728
medication safety; patient safety pharmacy education; science of safety; education
9.  Pharmacy Students’ Retention of Knowledge of Drug-Drug Interactions 
Objectives. To evaluate pharmacy students' drug-drug interaction (DDI) knowledge retention over 1 year and to determine whether presenting DDI vignettes increased knowledge retention.
Methods. A knowledge assessment tool was distributed to fourth-year pharmacy students before and after completing a DDI educational session. The questionnaire was re-administered after 1 year to assess knowledge retention. During the intervening year, students had the option of presenting DDI case vignettes to preceptors and other health professionals as part of their advanced pharmacy practice experiences (APPEs).
Results. Thirty-four of 78 pharmacy students completed both the post-intervention and 1-year follow-up assessments. Students’ knowledge of 4 DDI pairs improved, knowledge of 3 DDI pairs did not change, and knowledge of the remainder of DDI pairs decreased. Average scores of the 18 students who completed all tests and presented at least 1 vignette during their APPEs were higher on the 1-year follow-up assessment than students who did not, suggesting greater DDI knowledge retention (p = 0.04).
Conclusion. Although pharmacy students’ overall DDI knowledge decreased in the year following an educational session, those who presented vignettes to health professionals retained more DDI knowledge, particularly on those DDIs for which they gave presentations. Other methods to enhance pharmacy students’ retention of DDI knowledge of clinically important DDIs are needed.
doi:10.5688/ajpe756110
PMCID: PMC3175677  PMID: 21931448
drug-drug interaction; assessment
10.  Teaching the Science of Safety in US Colleges and Schools of Pharmacy 
This paper provides baseline information on integrating the science of safety into the professional degree curriculum at colleges and schools of pharmacy. A multi-method examination was conducted that included a literature review, key informant interviews of 30 individuals, and in-depth case studies of 5 colleges and schools of pharmacy. Educators believe that they are devoting adequate time to science of safety topics and doing a good job teaching students to identify, understand, report, manage, and communicate medication risk. Areas perceived to be in need of improvement include educating pharmacy students about the Food and Drug Administration's (FDA's) role in product safety, how to work with the FDA in post-marketing surveillance and other FDA safety initiatives, teaching students methods to improve safety, and educating students to practice in interprofessional teams. The report makes 10 recommendations to help pharmacy school graduates be more effective in protecting patients from preventable drug-related problems.
PMCID: PMC3138345  PMID: 21769153
safety; curriculum; pharmacy education; FDA; quality
11.  Practitioners’ Views on Computerized Drug–Drug Interaction Alerts in the VA System 
Objectives
To assess Veterans Affairs (VA) prescribers’ and pharmacists’ opinions about computer-generated drug–drug interaction (DDI) alerts and obtain suggestions for improving DDI alerts.
Design
A mail survey of 725 prescribers and 142 pharmacists from seven VA medical centers across the United States.
Measurements
A questionnaire asked respondents about their sources of drug and DDI information, satisfaction with the combined inpatient and outpatient computerized prescriber order entry (CPOE) system, attitude toward DDI alerts, and suggestions for improving DDI alerts.
Results
The overall response rate was 40% (prescribers: 36%; pharmacists: 59%). Both prescribers and pharmacists indicated that the CPOE system had a neutral to positive impact on their jobs. DDI alerts were not viewed as a waste of time and the majority (61%) of prescribers felt that DDI alerts had increased their potential to prescribe safely. However, only 30% of prescribers felt DDI alerts provided them with what they needed most of the time. Both prescribers and pharmacists agreed that DDI alerts should be accompanied by management alternatives (73% and 82%, respectively) and more detailed information (65% and 89%, respectively). When asked about suggestions for improving DDI alerts, prescribers most preferred including management options whereas pharmacists most preferred making it more difficult to override lethal interactions. Prescribers and pharmacists reported primarily relying on electronic references for general drug information (62% and 55%, respectively) and DDI information (51% and 79%, respectively).
Conclusion
Respondents reported neutral to positive views regarding the effect of CPOE on their jobs. Their opinions suggest DDI alerts are useful but still require additional work to increase their clinical utility.
doi:10.1197/jamia.M2224
PMCID: PMC2215077  PMID: 17068346

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