Pharmacotherapeutic actions related to drug interaction alerts - a questionnaire study among Swedish hospital interns and residents in family medicine.

Abstract

Purpose: To explore how hospital interns and residents specialising in family medicine act on drug interaction alerts in a specific patient case, and on interaction alerts in general.

Methods: A 4-page questionnaire, including a fictional patient case (73-year-old woman; 10 drugs in the medication list triggering 11 drug interaction alerts) and questions regarding the use of interaction alerts in general, was distributed to interns and residents during educational sessions (November‒December 2023). The respondents were instructed to consider what actions they would take "a normal day at work" due to the risk of interactions between the patients' drugs. In the general questions, the respondents were asked how often they access the detailed interaction information (from 1 = never to 5 = always) provided by the knowledge resource, in relation to the alert classification (D = clinically significant, should be avoided; C = clinically significant, can be handled by, e.g., dose adjustment).

Results: The questionnaire was completed by 55 interns and 69 residents (response rate: 98%). In the patient case, the respondents acted on a median of 4 (range: 0‒8) drugs, most often concerning repaglinide (in a D interaction alert with clopidogrel; 96% of the interns and 96% of the residents suggested action), and omeprazole (in three C interaction alerts with citalopram, clopidogrel, and levothyroxine, respectively; 71% and 83% suggested action). Among the respondents who answered the questions about how often (rated 4/5) they access more detailed information about interactions, 56 (59%) did so for D versus 29 (31%) for C alerts (P < 0.001).

Conclusion: Physicians act on drug interaction alerts selectively, and the alert classifications seem to guide how they are used.