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Browsing by Subject "outpatient care"

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  • Nieminen, Emmi (2016)
    Adverse drug events (ADE) are a major problem which deteriorates the quality of drug therapy. They cause significant morbidity and mortality each year. ADEs are often caused by incompatible drug combinations, drug-drug interactions (DDIs). Interprosessional collaboration between health care professionals is important in improving medication safety and preventig drug interactions. The aim of this study was to investigate the most common clinically significant drug-drug interactions in outpatient care and the role of pharmacist in preventing them. The study material was an interaction data which was collected in Helsinki University Pharmacy during August 2015. DDIs and the action needed by presecribers or pharmacists to handle them were collected. Only clinically significant interactions of the SFINX interaction database i.e. D- and C-interactions were recorded. The most common D-interactions (interactions to be avoided) were fluoroquinolones or tetracyclines combined with metal ions (calcium, iron, magnesium, aluminium) (14.7 % of D-interactions) and codeine or tramadol combined with CYP2D6 enzyme inhibiting antidepressants (12.6 %). C-interactions concerned most commonly interactions between antihypertensive drugs and NSAIDs (26.2 % of C-interactions). 59.6 % of D-interactions were interactions that might result in adverse drug reactions and 40.4 % were interactions that might result in therapeutic failure. For C-interactions numbers were 49.4 % and 50.6 %, respectively. Only a few interactions (1.6 %) led to contact with the prescriber from the pharmacy, and more often (1.8 %) the pharmacist advised the patient to contact the prescriber. 32.6 % of the interactions led to pharmacist's advice. The most typical interactions which can be prevented by pharmacist's advice were chelation interactions which can be prevented by taking drugs many hours apart from each other. 59.7 % of the interactions produced no action in pharmacy. Those concerned situations where the prescriber had planned the treatment and weighed up the benefits and risks of the medication, or interactions where the drugs had been in contemporary use for a long time, and thus the pharmacist assumed that the prescriber had planned the treatment. Pharmacists should intervene in drug-drug interactions easier. To avoid unnecessary calls, communication between prescribers and community pharmacies should be developed. Pharmacists' role in preventing DDIs could be improved for example by education and by updating the operations models in collaboration with other health care. Safe and efficient drug treatment should be ensured with interprofessional collaboration, and the responsibility should not be shifted to the patient alone.