Drug-Drug Interaction Assessment and Identification in the Primary Care Setting

John Peabody; Maria Czarina Acelajado; Tim Robert; Cheryl Hild; Joshua Schrecker; David Paculdo; Mary Tran; Elaine Jeter

doi:10.14740/jocmr3557w

Drug-Drug Interaction Assessment and Identification in the Primary Care Setting

J Clin Med Res. 2018 Nov;10(11):806-814. doi: 10.14740/jocmr3557w. Epub 2018 Oct 9.

Authors

John Peabody^{1

2

3}, Maria Czarina Acelajado⁴, Tim Robert⁵, Cheryl Hild⁵, Joshua Schrecker⁵, David Paculdo³, Mary Tran³, Elaine Jeter⁵

Affiliations

¹ University of California, San Francisco, CA, USA.
² University of California, Los Angeles, CA, USA.
³ QURE Healthcare, San Francisco, CA, USA.
⁴ Athens Limestone Hospital, Athens, AL, USA.
⁵ Aegis Sciences Corporation, Nashville, TN, USA.

Abstract

Background: Drug-drug interactions (DDIs) are ubiquitous, harmful and a leading cause of morbidity and mortality. With an aging population, growth in polypharmacy, widespread use of supplements, and the rising opioid abuse epidemic, primary care physicians (PCPs) are increasingly challenged with identifying and preventing DDIs. We set out to evaluate current clinical practices related to identifying and treating DDIs and to determine if opportunities to increase prevention of DDIs and their adverse events could be identified.

Methods: In a nationally representative sample of 330 board-certified family and internal medicine practitioners, we evaluated whether PCPs assessed DDIs in the care they provided for three simulated patients. The patients were taking common prescription medications (e.g. opioids and psychiatric medications) along with other common ingestants (e.g. supplements and food) and presented with symptoms of DDIs. Physicians were scored on their ability to inquire about the patient's medications, investigate possible DDIs, evaluate the patient, and provide treatment recommendations. We scored the physicians' care recommendations against evidence-based criteria, including overall care quality and treatment for DDIs.

Results: Average overall quality of care score was 50.5% ± 12.0%. Despite >99% self-reported use of medication reconciliation practices and tools, physicians identified DDIs in only 15.3% of patients, with 15.5% ± 20.3% of DDI-specific treatment by the physicians.

Conclusions: PCPs in this study did not recognize or adequately treat DDIs. Better methods are needed to screen for DDIs in the primary care setting.

Keywords: Adverse drug event; Drug-drug interaction; Drug-food interaction; Drug-supplement interaction; Medication reconciliation; Opioids; Primary care; Psychiatric medications.