Skip to main content
Top
Published in: International Journal of Clinical Pharmacy 3/2017

01-06-2017 | Research Article

A survey of attitudes, practices, and knowledge regarding drug–drug interactions among medical residents in Iran

Authors: Ehsan Nabovati, Hasan Vakili-Arki, Zhila Taherzadeh, Mohammad Reza Saberi, Ameen Abu-Hanna, Saeid Eslami

Published in: International Journal of Clinical Pharmacy | Issue 3/2017

Login to get access

Abstract

Background When prescribing medications, physicians should recognize clinically relevant potential drug–drug interactions (DDIs). To improve medication safety, it is important to understand prescribers’ knowledge and opinions pertaining to DDIs. Objective To determine the current DDI information sources used by medical residents, their knowledge of DDIs, their opinions about performance feedback on co-prescription of interacting drugs. Setting Academic hospitals of Mashhad University of Medical Sciences (MUMS) in Iran. Methods A questionnaire containing questions regarding demographic and practice characteristics, DDI information sources, ability to recognize DDIs, and opinions about performance feedback was distributed to medical residents of 22 specialties in eight academic hospitals in Iran. We analyzed their perception pertaining to DDIs, their performance on classifying drug pairs, and we used a linear regression model to assess the association of potential determinants on their DDI knowledge. Main Outcome Measure prescribers’ knowledge and opinions pertaining to DDIs. Results The overall response rate and completion rate for 315 distributed questionnaires were 90% (n = 295) and 86% (n = 281), respectively. Among DDI information sources, books, software on mobile phone or tablet, and Internet were the most commonly-used references. Residents could correctly classify only 41% (5.7/14) of the drug pairs. The regression model showed no significant association between residents’ characteristics and their DDI knowledge. An overwhelming majority of the respondents (n = 268, 95.4%) wished to receive performance feedback on co-prescription of interacting drugs in their prescriptions. They mostly selected information technology-based tools (i.e. short text message and email) as their preferred method of receiving feedback. Conclusion Our findings indicate that prescribers may have poor ability to prevent clinically relevant potential DDI occurrence, and they perceive the need for performance feedback. These findings underline the importance of well-designed computerized alerting systems and delivering performance feedback to improve patient safety.
Literature
1.
go back to reference Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.CrossRefPubMed Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug–drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16:641–51.CrossRefPubMed
2.
go back to reference Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23:489–97.CrossRefPubMed Dechanont S, Maphanta S, Butthum B, Kongkaew C. Hospital admissions/visits associated with drug–drug interactions: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2014;23:489–97.CrossRefPubMed
3.
go back to reference Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–8.CrossRefPubMed Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug–drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–8.CrossRefPubMed
4.
go back to reference Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician’s expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg. 2014;69:157–64.CrossRefPubMed Cornu P, Steurbaut S, De Beukeleer M, Putman K, van de Velde R, Dupont AG. Physician’s expectations regarding prescribing clinical decision support systems in a Belgian hospital. Acta Clin Belg. 2014;69:157–64.CrossRefPubMed
5.
go back to reference Malone DC, Liberman JN, Sun D. Effect of an educational outreach program on prescribing potential drug–drug interactions. J Managed Care Pharm. 2013;19:549–57.CrossRef Malone DC, Liberman JN, Sun D. Effect of an educational outreach program on prescribing potential drug–drug interactions. J Managed Care Pharm. 2013;19:549–57.CrossRef
6.
go back to reference Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract. 2009;7:242–7. Bista D, Saha A, Mishra P, Palaian S, Shankar PR. Impact of educational intervention on the pattern and incidence of potential drug–drug interactions in Nepal. Pharm Pract. 2009;7:242–7.
7.
go back to reference Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug–drug interaction database SFINX on prevalence of potentially serious drug–drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69:565–71.CrossRefPubMed Andersson ML, Bottiger Y, Lindh JD, Wettermark B, Eiermann B. Impact of the drug–drug interaction database SFINX on prevalence of potentially serious drug–drug interactions in primary health care. Eur J Clin Pharmacol. 2013;69:565–71.CrossRefPubMed
8.
go back to reference Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166:1009–15.CrossRefPubMed Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166:1009–15.CrossRefPubMed
9.
go back to reference Strom BL, Schinnar R, Bilker W, Hennessy S, Leonard CE, Pifer E. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID-warfarin co-prescribing as a test case. J Am Med Inform Assoc JAMIA. 2010;17:411–5.CrossRefPubMed Strom BL, Schinnar R, Bilker W, Hennessy S, Leonard CE, Pifer E. Randomized clinical trial of a customized electronic alert requiring an affirmative response compared to a control group receiving a commercial passive CPOE alert: NSAID-warfarin co-prescribing as a test case. J Am Med Inform Assoc JAMIA. 2010;17:411–5.CrossRefPubMed
10.
go back to reference Armstrong EP, Wang SM, Hines LE, Gao S, Patel BV, Malone DC. Evaluation of a drug–drug interaction: fax alert intervention program. BMC Med Inform Decis Mak. 2013;13:32.CrossRefPubMedPubMedCentral Armstrong EP, Wang SM, Hines LE, Gao S, Patel BV, Malone DC. Evaluation of a drug–drug interaction: fax alert intervention program. BMC Med Inform Decis Mak. 2013;13:32.CrossRefPubMedPubMedCentral
11.
go back to reference Glassman PA, Belperio P, Lanto A, Simon B, Valuck R, Sayers J, et al. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. J Am Med Inform Assoc JAMIA. 2007;14:424–31.CrossRefPubMed Glassman PA, Belperio P, Lanto A, Simon B, Valuck R, Sayers J, et al. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population. J Am Med Inform Assoc JAMIA. 2007;14:424–31.CrossRefPubMed
12.
go back to reference Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.CrossRefPubMed Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36:665–72.CrossRefPubMed
13.
go back to reference Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care. Am J Med Qual. 2011;26:145–53.CrossRefPubMed Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B. A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care. Am J Med Qual. 2011;26:145–53.CrossRefPubMed
14.
go back to reference Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.CrossRefPubMed Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.CrossRefPubMed
15.
go back to reference Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE, Abarca J, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31:525–36.CrossRefPubMed Ko Y, Malone DC, Skrepnek GH, Armstrong EP, Murphy JE, Abarca J, et al. Prescribers’ knowledge of and sources of information for potential drug–drug interactions: a postal survey of US prescribers. Drug Saf. 2008;31:525–36.CrossRefPubMed
16.
go back to reference Hincapie AL, Warholak TL, Hines LE, Taylor AM, Malone DC. Impact of a drug–drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: a 1-year follow-up. Res Soc Adm Pharm RSAP. 2012;8:472–7.CrossRef Hincapie AL, Warholak TL, Hines LE, Taylor AM, Malone DC. Impact of a drug–drug interaction intervention on pharmacy and medical students’ knowledge and attitudes: a 1-year follow-up. Res Soc Adm Pharm RSAP. 2012;8:472–7.CrossRef
17.
go back to reference Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug–drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU. 2014;22:52.CrossRefPubMedPubMedCentral Nabovati E, Vakili-Arki H, Taherzadeh Z, Hasibian MR, Abu-Hanna A, Eslami S. Drug–drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature. DARU. 2014;22:52.CrossRefPubMedPubMedCentral
18.
go back to reference Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30:607–10.CrossRef Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30:607–10.CrossRef
19.
go back to reference Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27:94–104.CrossRef Rubio DM, Berg-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: conducting a content validity study in social work research. Soc Work Res. 2003;27:94–104.CrossRef
20.
go back to reference Warholak TL, Menke JM, Hines LE, Murphy JE, Reel S, Malone DC. A drug–drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence. Res Soc Adm Pharm RSAP. 2011;7:16–26.CrossRef Warholak TL, Menke JM, Hines LE, Murphy JE, Reel S, Malone DC. A drug–drug interaction knowledge assessment instrument for health professional students: a Rasch analysis of validity evidence. Res Soc Adm Pharm RSAP. 2011;7:16–26.CrossRef
21.
go back to reference Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994. Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
22.
go back to reference Budtz-Jorgensen E, Keiding N, Grandjean P, Weihe P. Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol. 2007;17:27–35.CrossRefPubMed Budtz-Jorgensen E, Keiding N, Grandjean P, Weihe P. Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure. Ann Epidemiol. 2007;17:27–35.CrossRefPubMed
23.
go back to reference Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A, et al. Practitioners’ views on computerized drug–drug interaction alerts in the VA system. J Am Med Inform Assoc JAMIA. 2007;14:56–64.CrossRefPubMed Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A, et al. Practitioners’ views on computerized drug–drug interaction alerts in the VA system. J Am Med Inform Assoc JAMIA. 2007;14:56–64.CrossRefPubMed
24.
go back to reference Abbasi Nazari M, Salamzadeh J, Hajebi G, Gilbert B. The role of clinical pharmacists in educating nurses to reduce drug–food interactions (absorption phase) in hospitalized patients. Iran J Pharm Res IJPR. 2011;10:173–7.PubMed Abbasi Nazari M, Salamzadeh J, Hajebi G, Gilbert B. The role of clinical pharmacists in educating nurses to reduce drug–food interactions (absorption phase) in hospitalized patients. Iran J Pharm Res IJPR. 2011;10:173–7.PubMed
25.
go back to reference Abbasinazari M, Hajhossein Talasaz A, Eshraghi A, Sahraei Z. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica. 2013;51:482–6.PubMed Abbasinazari M, Hajhossein Talasaz A, Eshraghi A, Sahraei Z. Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica. 2013;51:482–6.PubMed
26.
go back to reference Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm. 2011;33:281–4.CrossRefPubMed Khalili H, Farsaei S, Rezaee H, Dashti-Khavidaki S. Role of clinical pharmacists’ interventions in detection and prevention of medication errors in a medical ward. Int J Clin Pharm. 2011;33:281–4.CrossRefPubMed
27.
go back to reference Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S. Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. Eur J Intern Med. 2013;24:227–33.CrossRefPubMed Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S. Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. Eur J Intern Med. 2013;24:227–33.CrossRefPubMed
28.
go back to reference Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26:423–36.CrossRefPubMed Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009;26:423–36.CrossRefPubMed
29.
go back to reference Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nursing. 2006;27:118–29.CrossRef Yoon SL, Schaffer SD. Herbal, prescribed, and over-the-counter drug use in older women: prevalence of drug interactions. Geriatr Nursing. 2006;27:118–29.CrossRef
30.
go back to reference Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population. Eur J Clin Pharmacol. 2000;56:495–9.CrossRefPubMed Sihvo S, Klaukka T, Martikainen J, Hemminki E. Frequency of daily over-the-counter drug use and potential clinically significant over-the-counter-prescription drug interactions in the Finnish adult population. Eur J Clin Pharmacol. 2000;56:495–9.CrossRefPubMed
31.
go back to reference Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.CrossRefPubMedPubMedCentral Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867–78.CrossRefPubMedPubMedCentral
32.
go back to reference Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging. 2014;31:527–40.CrossRefPubMed Peklar J, Henman MC, Kos M, Richardson K, Kenny RA. Concurrent use of drugs and supplements in a community-dwelling population aged 50 years or more: potential benefits and risks. Drugs Aging. 2014;31:527–40.CrossRefPubMed
33.
go back to reference Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, et al. Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. J Am Pharm Assoc JAPhA. 2004;44:142–51.CrossRef Malone DC, Abarca J, Hansten PD, Grizzle AJ, Armstrong EP, Van Bergen RC, et al. Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. J Am Pharm Assoc JAPhA. 2004;44:142–51.CrossRef
34.
35.
go back to reference Ko Y, Malone DC, D’Agostino JV, Skrepnek GH, Armstrong EP, Brown M, et al. Potential determinants of prescribers’ drug–drug interaction knowledge. Res Soc Adm Pharm RSAP. 2008;4:355–66.CrossRef Ko Y, Malone DC, D’Agostino JV, Skrepnek GH, Armstrong EP, Brown M, et al. Potential determinants of prescribers’ drug–drug interaction knowledge. Res Soc Adm Pharm RSAP. 2008;4:355–66.CrossRef
36.
go back to reference Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharm. 2011;9:364–77.CrossRef Hines LE, Murphy JE. Potentially harmful drug–drug interactions in the elderly: a review. Am J Geriatr Pharm. 2011;9:364–77.CrossRef
37.
go back to reference Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm. 2016;38:1052–6.CrossRefPubMed Ismail M, Khan F, Noor S, Haider I, Haq IU, Ali Z, et al. Potential drug–drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan. Int J Clin Pharm. 2016;38:1052–6.CrossRefPubMed
38.
go back to reference Nabovati E, Vakili-Arki H, Taherzadeh Z, Saberi MR, Abu-Hanna A, Eslami S. Incidence rate and pattern of clinically relevant potential drug–drug interactions in a large outpatient population of a developing country. Res Pharm Sci. 2016;11:233–42.PubMedPubMedCentral Nabovati E, Vakili-Arki H, Taherzadeh Z, Saberi MR, Abu-Hanna A, Eslami S. Incidence rate and pattern of clinically relevant potential drug–drug interactions in a large outpatient population of a developing country. Res Pharm Sci. 2016;11:233–42.PubMedPubMedCentral
39.
go back to reference Stoll P, Kopittke L. Potential drug–drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm. 2015;37:475–84.CrossRefPubMed Stoll P, Kopittke L. Potential drug–drug interactions in hospitalized patients undergoing systemic chemotherapy: a prospective cohort study. Int J Clin Pharm. 2015;37:475–84.CrossRefPubMed
Metadata
Title
A survey of attitudes, practices, and knowledge regarding drug–drug interactions among medical residents in Iran
Authors
Ehsan Nabovati
Hasan Vakili-Arki
Zhila Taherzadeh
Mohammad Reza Saberi
Ameen Abu-Hanna
Saeid Eslami
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
International Journal of Clinical Pharmacy / Issue 3/2017
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-017-0453-3

Other articles of this Issue 3/2017

International Journal of Clinical Pharmacy 3/2017 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.