Download Drug interactions detected using Electronic Care Records

Drug interactions detected using
Electronic Care Records
Rafferty P, Dinsmore WW , Donnelly CM,
Emerson CR, McCarty EJ, Quah SP, McMullan k,
Curran S.
Department of Genito-Urinary Medicine, RVH,
Belfast.
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Background
Method
Results
Conclusions
Recommendations
Questions
Background
• HIV clinicians are very aware of drug-drug
interactions (DDI’s)and how to manage.
• We were concerned that patients could be
harmed from DDI’s.
• Patient confidentiality and communication
with other healthcare professionals is a
challenge.
• SSSTDI 2013 reinforced DDI issue
Background
• In 2013, Northern Ireland Electronic Care
Record (NIECR) was launched.
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Background
Method
Results
Conclusions
Recommendations
Questions
Method
• All patients on a boosted anti-retroviral
regimen containing ritonavir or cobicistat
were identified using JAC.
• GP medication records were accessed via
NIECR to undertake an interaction screen.
• Interaction checks done using Liverpool, eMC
and regional Medicines information centre.
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Background
Method
Results
Conclusions
Recommendations
Questions
Results
• 331 patients were identified as taking a boosted
antiretroviral regimen.
• 317 were accessed via NIECR.
• 144 (45%) patients were prescribed medication
by their GP.
• 114 (80%) required a dose adjustment of GP
medication, monitoring advice or ARV medication
change.
• 56 patients (17.5%) required an immediate
clinical intervention.
Results
• Interventions made by age group
Results
• 114 interventions
• 7 x Duplication of prescribing
PDE5 inhibitors, hypnotics, tramadol
• 19 x Inhaled steroids– fluticasone, budesonide
Seretide, Flixonase, Symbicort
• 88 x Dose adjustment or dose reduction
Results
• Priority interventions
 Inhaled Steroids (19)
 Quetiapine alert 2014 (4)
 Domperidone alert 2014 (4)
 NOAC/anti-platelets (4)
 Lercanidipine (2)
Results
• Dose/drug adjustment (88)
 Anti-depressants (25)
 Statins (14)
 Long term NSAID’s (6)
 Chelation (4)
 Lercanidipine (2)
 Others include COC, anti-hypertensive, warfarin, tamoxifen
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Background
Method
Results
Conclusions
Recommendations
Questions
Conclusions
• DDI’s are very common (8/10) with medicines
prescribed by GP’s or other hospital
specialities.
• Medicines contra-indicated with protease
inhibitors were prescribed.
• DDI’s have the potential to cause serious harm
to patients.
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Background
Method
Results
Conclusions
Recommendations
Questions
Recommendations
• Education of Clinicians to check for HIV DDI’s is needed
• Patients should prompt other practitioners to check for
DDI’s.
• HIV/GUM clinicians should enquire from patients at each
review if they have started any new medications, inhalers
or patches since their last visit.
• A medicines reconciliation and interaction check should
be completed before commencing or switching a
patient’s antiretroviral regime.
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Background
Method
Results
Conclusions
Recommendations
 Questions?