An Epidemiological Study of the Clinical Significance of Drug-Drug Interactions in A Private Community Hospital

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Abstract
The primary objective of the study was to determine the clinical significance (to the patient's disease course) of drug-drug interactions in a 453-bed private, community hospital. Prospective epidemiologic methods with computer support were used. The medication orders of all the patients in the hospital were screened by computer to detect the existence of potentially interacting drug combinations. The computer was programmed with 108 literature-documented drug-drug interactions. The interactions so detected and printed-out by the computer were investigated daily in the patients' charts by a pharmacist-monitor. The charts were searched for signs of drug-drug interaction, e.g., altered drug effects or laboratory values, or other changes in therapy that could be related to the interactions being investigated. Whenever such evidence was found, the attending physician was consulted to determine the validity and clinical significance of the interaction. Interactions were graded by the physician as having no, minor, or major clinical significance to the patient. Over 2,400 patients, representing over 25,000 patient-days of drug therapy, were monitored over a two-month period. The results of the study indicated that although many potentially interacting drug combinations were prescribed for these patients, few experienced a significant adverse drug-drug interaction. The role of the pharmacist as a monitor of drug interactions and the effectiveness of the computer system as an initial screen were also evaluated.

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