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Br J Clin Pharmacol. 2015 Dec;80(6):1411-20. doi: 10.1111/bcp.12754. Epub 2015 Nov 12.

Clinically important drug-drug interactions in poly-treated elderly outpatients: a campaign to improve appropriateness in general practice.

Author information

1
Department of Medical and Surgical Sciences - Pharmacology Unit, University of Bologna, Bologna.
2
Local Health Authority Reggio Emilia.
3
Local Health Authority Bologna.
4
Local Health Authority Modena.
5
Local Health Authority, Ferrara.
6
Local Health Authority Parma.
7
Local Health Authority Piacenza.
8
Local Health Authority Forlì
9
Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy.

Abstract

AIMS:

The aim was to assess the impact of a campaign for general practitioners (GPs) to reduce clinically-important drug-drug interactions (DDIs) in poly-treated elderly patients.

METHODS:

We compiled a list of 53 DDIs and analyzed reimbursed prescriptions dispensed to poly-treated (≥four drugs) elderly (>65 years) patients in the Emilia Romagna region during January 2011-June 2011 (first pre-intervention period), January 2012-June 2012 (second pre-intervention period) and January 2013-June 2013 (post-intervention period). Educational initiatives to GPs were completed in July 2012-December 2012. Pre-test/post-test analysis (2013 vs. 2012) was performed, also using predicted 2013 data (P < 0.01 for statistical significance).

RESULTS:

Despite the slight increase in poly-therapy rate (16% in 2013, +1.5% from 2011), we found a stable or slightly declining number of potential DDIs for each elderly poly-treated patient (~1.5). In 2013, 11 DDIs exceeded 5% of prevalence rate: antidiabetics-β-adrenoceptor blockers ranked first (20.3%), followed by ACE Inhibitors (ACEIs)/sartans-non steroidal anti-inflammatory drugs (NSAIDs) (16.4%), diuretics-NSAIDs (13.6%), selective serotonin re-uptake inhibitors (SSRIs)-NSAIDs/acetyl salicylic acid (ASA) (12.7%) and corticosteroids-NSAIDs/ASA (9.7%). A remarkable reduction emerged for NSAID-related DDIs (diuretics-NSAIDs peaked -14.5%; P < 0.01), whereas prevalence of antidiabetics-β-adrenoceptor blockers increased (+7.9%; P < 0.01). When using predicted values, the statistical significance disappeared for antidiabetics-β-adrenoceptor blockers (+1.3%; P = 0.04), whereas it persisted for almost all NSAIDs-related DDIs: ACEIs/sartans-NSAIDs (-3.0%), diuretics-NSAIDs (-6.0%), SSRIs-NSAIDs/ASA (-5.9%).

CONCLUSIONS:

This campaign contained the burden of DDIs in poly-treated elderly patients by 1) reducing most prevalent DDIs, especially NSAIDs-related DDIs and 2) balancing the observed rise in poly-therapy rate with stable rate in overall prescriptions of potentially interacting drugs per patient.

KEYWORDS:

appropriateness; drug-drug interactions; elderly; non-steroidal antinflammatory drugs

PMID:
26303150
PMCID:
PMC4693493
DOI:
10.1111/bcp.12754
[Indexed for MEDLINE]
Free PMC Article

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