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Reducing warfarin medication interactions: an interrupted time series evaluation.

Adrianne C Feldstein1, David H Smith, Nancy Perrin

  • 1Center for Health Research, Kaiser Permanente, 3800 N. Interstate Avenue, Portland, OR 97227, USA. Adrianne.C.Feldstein@kpchr.org

Archives of Internal Medicine
|May 10, 2006
PubMed
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Electronic health record alerts modestly reduced warfarin-interacting medication coprescribing in outpatients. Group academic detailing did not improve alert effectiveness, indicating a need for further strategies to prevent inappropriate drug combinations.

Area of Science:

  • Clinical Pharmacy
  • Health Informatics
  • Pharmacovigilance

Background:

  • Computerized decision support systems (CDSS) are effective for inpatient medication errors but have limited evidence for reducing drug-drug interactions in outpatients.
  • The role of academic detailing in enhancing medication interaction alerts is uncertain.

Purpose of the Study:

  • To evaluate the effectiveness of electronic health record (EHR) alerts and group academic detailing in reducing the coprescribing of warfarin with interacting medications in an outpatient setting.

Main Methods:

  • An interrupted time series design was employed in a health maintenance organization with an EHR.
  • 239 primary care providers and 9910 warfarin users were included.
  • EHR alerts for 5 warfarin-interacting medications were implemented across all 15 clinics; 7 clinics received additional group academic detailing.

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Main Results:

  • A 14.9% relative reduction in the warfarin-interacting medication prescription rate was observed within 12 months of alert implementation.
  • The interacting prescription rate decreased from 3294.0 to 2804.2 per 10,000 warfarin users per month.
  • Group academic detailing did not significantly enhance the effectiveness of the EHR alerts.

Conclusions:

  • Medication interaction alerts in EHRs can modestly reduce the coprescribing of interacting medications in ambulatory care.
  • Further interventions are necessary to further decrease the inappropriate prescribing of warfarin with interacting drugs.