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Detection of potential drug interactions: a model for a national pharmacy register
University of Kalmar, School of Pure and Applied Natural Sciences.
Uppsala universitet.
Apoteket AB, Stockholm.
University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.ORCID iD: 0000-0002-4295-7201
2006 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 62, no 9, p. 749-756Article in journal (Refereed) Published
Abstract [en]

Objective  The widespread use of pharmaceuticals prescribed by different physicians has caused the Swedish government to propose a new legislation with registration of all prescriptions dispensed at the Swedish pharmacies. In the present study, we wanted to examine the frequency, distribution and determinants of potential drug interactions.Methods  The prescriptions from all individuals (n=8,214) with two or more prescriptions during October 2003 to December 2004 were collected from the ongoing Jämtland cohort study of a total of about 11,000 individuals. Potential drug–drug interactions were detected with a computerized interaction detection system and classified according to clinical relevance (types A–D).Results  On average each individual filled 14.6 (men 14.3, women 14.8) prescriptions during the study period. 3.6% of the individuals used more than 15 different drugs. The number of detected potential drug interactions type A–D was 4,941 (men 1,949, women 2,992). The risk of receiving a potential interaction type A–D was estimated as the cumulative incidence 0.26 (2,116/8,214) overall, 0.22 (748/3,467) for men and 0.29 (1,368/4,747) for women during the 15-month study period. The age adjusted risk, RRadj, for women was estimated as 1.30. Excluding sex hormones and modulators of the genital system, the RRadj was 0.96, with no elevated risk for women. For potential interactions type D, that might have serious clinical consequences, 167 (cumulative incidence 0.0203) individuals (72 men, cumulative incidence 0.0208, 95 women cumulative incidence 0.0200) were detected. The risk of receiving a combination of potentially interacting drugs was positively correlated to age and polypharmacy. The cumulative incidence for elderly was estimated as 0.36 (65–84 years) and 0.39 (85 years and above). The relative risk for individuals with 15 drugs or more was estimated as 3.67 (95% CI 3.46–3.90).Conclusion  In a general population there were relatively few severe potential drug interactions. The new Swedish national pharmacy register will provide health care professionals with a powerful tool to systematically review all prescriptions. An alert system should focus on the more potential drug interactions, type C–D, with close monitoring of elderly and patients with polypharmacy.

Place, publisher, year, edition, pages
2006. Vol. 62, no 9, p. 749-756
Keywords [en]
Community pharmacy services, Decision making, Computer-assisted, Drug interactions, Drug/statistics and numerical data, Drug therapy/adverse effects, Drug utilization, Humans, Polypharmacy, Prescriptions, Sweden/epidemiology
National Category
Biomedical Laboratory Science/Technology
Research subject
Biomedical Sciences, Pharmacology
Identifiers
URN: urn:nbn:se:hik:diva-618DOI: 10.1007/s00228-006-0143-xOAI: oai:DiVA.org:hik-618DiVA, id: diva2:1869
Available from: 2007-11-26 Created: 2009-04-17 Last updated: 2017-12-13Bibliographically approved
In thesis
1. ePrescribing: Studies in Pharmacoinformatics
Open this publication in new window or tab >>ePrescribing: Studies in Pharmacoinformatics
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Det övergripande syftet med den här avhandlingen har varit att, inom området läkemedelsinformatik, studera utvecklingen av elektroniska stöd inom läkemedelsförskrivning; för klinisk praxis, uppföljning och forskning.

Under århundraden har det handskrivna receptet varit det sätt, med vilket läkare förmedlat sina läkemedelsordinationer till apotekare, vilket också för patienten blivit en informationskälla för hur läkemedel ska användas för att göra bästa nytta. Nu genomgår receptet en förändring från pappersbaserat till elektroniskt meddelande och att anpassa en traditionell process till en ny elektronisk era innebär både möjligheter och utmaningar.

Studierna som ingår i avhandlingen har visat att exponeringen av förskrivna läkemedel i en allmän befolkning har ökat under de senaste tre decennierna. Risken för potentiella interaktioner mellan läkemedel, varmed avses den risk som finns att olika läkemedel kan påverka varandras effekter och biverkningar, har också visat sig öka starkt desto fler läkemedel som används av en individ. Denna ökade samtidiga användning av flera olika läkemedel, så kallad polyfarmaci, medför att det finns en större anledning för förskrivare och farmacevter att uppmärksamma risken för potentiella interaktioner mellan läkemedel.

De nyinrättade nationella receptregistren över uthämtad receptförskriven medicin bör användas bland annat för att upptäcka potentiella läkemedelsinteraktioner, såväl i vårdens utövning som inom läkemedelsepidemiologisk forskning. Den svenska läkemedelsförteckningen, som omfattar information om uthämtade receptförskrivna läkemedel för huvuddelen av den svenska befolkningen, bedöms ha en stor klinisk potential. Den enskilde individens historiska information om uthämtade läkemedel är tillgänglig för individen på Internet med hjälp av e-legitimation; även förskrivare och farmacevter på apotek kan ta del av informationen med den enskildes samtycke. Brist på tillgång till enhetliga och säkra autenticeringsmetoder inom hälso- och sjukvården kan dock fördröja tillgången på individuell läkemedelsinformation för förskrivare. I och med att de flesta recepten i Sverige nu skrivs och överförs elektroniskt är det viktigt att kvalitetsmässiga aspekter tas tillvara så att en iakttagen ökad risk för receptförskrivningsfel inte överförs i informationskedjan.

Avhandlingens slutsats är att e-förskrivning, med kommunikation och användning av lagrad information om receptexpeditioner, möjliggör att läkemedelsbehandling som process kan följas och studeras på ett helt nytt

Abstract [en]

The thesis aimed to study the developments, in the area of pharmacoinformatics, of the electronic prescribing and dispensing processes of drugs - in medical praxis, follow-up, and research.

For hundreds of years, the written prescription has been the method of choice for physicians to communicate decisions on drug therapy and for pharmacists to dispense medication. Successively the prescription has also become a source of information for the patient about how to use the medication to maximize its benefit. Currently, the medical prescription is at a transitional stage between paper and web, and to adapt a traditional process to the new electronic era offers both opportunities and challenges

The studies in the thesis have shown that the exposure of prescribed drugs in the general population has increased considerably over three decades. The risk of receiving potentially interacting drugs was also strongly correlated to the concomitant use of multiple drugs, polypharmacy. The pronounced increase in polypharmacy over time constitutes a growing reason for prescribers and pharmacists to be aware of drug interactions. Still, there were relatively few severe potential drug interactions.

Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically. The Swedish National Pharmacy Register provides prescription dispensing information for the majority of the population. The medication history in the register may be accessed online to improve drug utilization, by registered individuals, prescribers, and pharmacists in a safe and secure way. Lack of widespread secure digital signatures in healthcare may delay general availability. With a relatively high prevalence of dispensed drugs in the population, the National Pharmacy Register seems justified in evaluating individual medication history.

With a majority of prescriptions transferred as ePrescriptions, the detected increased risk for prescription errors warrants quality improvement, if the full potential of ePrescriptions is to be fulfilled.

The main conclusion of the studies was that ePrescribing with communication of prescribed drug information, storing and retrieving dispensed drug information, offers new opportunities for clinical and scientific

Place, publisher, year, edition, pages
Naturvetenskapliga institutionen, 2007
Series
Dissertation series / University of Kalmar, Faculty of Natural Science, ISSN 1650-2779 ; 48
Keywords
Community Pharmacy Services, Decision Making; computer-assisted, Drug Interactions, Drug Utilization/statistics & numerical data, ePrescribing, Medical Informatics, Medication Errors/prevention & control, Pharmacoinformatics, Polypharmacy
National Category
Biomedical Laboratory Science/Technology
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:hik:diva-32 (URN)978-91-89584-89-1 (ISBN)
Public defence
2007-12-18, Sal N 2007, Naturvetenskapliga institutionen, Smålandsgatan 26 B, Kalmar, 13:00 (English)
Opponent
Supervisors
Available from: 2007-11-26 Created: 2007-11-26 Last updated: 2017-05-30

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Åstrand, BengtPetersson, Göran

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