병용금기 약물의 처방 현황 분석을 통한 임상적 중재방안 제시
Suggestions for Pharmacists’ Intervention According to Analysis of Prescription Practices of Contraindicated Drug-Drug Interaction
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Background : In Korea, the Health Insurance Review and Assessment Service conducts prospectively inspections on prescription and dispensing for contraindications regarding drug-drug interaction, specific age groups, pregnancy and so forth. When some of contraindicated drug are prescribed, the reason for use must be specified. In 2016, the rate of prescription changes according to DUR contraindicated drug-drug interaction (CDDI) alert was approximately 30%. To find the cause of low prescription change rate, we analyzed the current status of prescriptions of CDDI. Methods : January to December 2019, we investigated basic information about prescriptions for which the reason is specified despite a CDDI alert at one tertiary hospital. We investigated the severity of the CDDI based on the tertiary literature and suggested clinical intervention for the relatively serious CDDI. Results : A total of 22,539 cases and 176 kinds of CDDI were prescribed despite a CDDI alert. The number of CDDI cases not administered simultaneously such as metformin-a contrast media was 1,346 (6.0%). The number of CDDI cases of the same efficacy group was 6,220 (27.6%). Also, 8,274 (36.7%) cases of CDDI had relatively low severity (Lexicomp B/C, Micromedex moderate) or no data. The remaining 6,699 cases (29.7%) were recommended to change the prescription according to the tertiary literature (Lexicomp D/X, Micromedex major/contraindicated). The common cases of CDDI were meropenem-valproic acid (554 cases), fluconazole-triazolam (189 cases) and itraconazole-triazolam (134 cases). Conclusion : The number of CDDI requiring interventions was 69. The intervention plan was suggested for 46 CDDI and recommended (1) changing from one of the drugs to drugs with the similar indication and relatively less drug-interaction, (2) antibiotics was retained and the other drugs were changed because the antibiotic range may be different. In the future, these interventions can be applied to a computer program or used by clinical pharmacists.
Abstract
Background : In Korea, the Health Insurance Review and Assessment Service conducts prospectively inspections on prescription and dispensing for contraindications regarding drug-drug interaction, specific age groups, pregnancy and so forth. When some of contraindicated drug are prescribed, the reason for use must be specified. In 2016, the rate of prescription changes according to DUR contraindicated drug-drug interaction (CDDI) alert was approximately 30%. To find the cause of low prescription change rate, we analyzed the current status of prescriptions of CDDI. Methods : January to December 2019, we investigated basic information about prescriptions for which the reason is specified despite a CDDI alert at one tertiary hospital. We investigated the severity of the CDDI based on the tertiary literature and suggested clinical intervention for the relatively serious CDDI. Results : A total of 22,539 cases and 176 kinds of CDDI were prescribed despite a CDDI alert. The number of CDDI cases not administered simultaneously such as metformin-a contrast media was 1,346 (6.0%). The number of CDDI cases of the same efficacy group was 6,220 (27.6%). Also, 8,274 (36.7%) cases of CDDI had relatively low severity (Lexicomp B/C, Micromedex moderate) or no data. The remaining 6,699 cases (29.7%) were recommended to change the prescription according to the tertiary literature (Lexicomp D/X, Micromedex major/contraindicated). The common cases of CDDI were meropenem-valproic acid (554 cases), fluconazole-triazolam (189 cases) and itraconazole-triazolam (134 cases). Conclusion : The number of CDDI requiring interventions was 69. The intervention plan was suggested for 46 CDDI and recommended (1) changing from one of the drugs to drugs with the similar indication and relatively less drug-interaction, (2) antibiotics was retained and the other drugs were changed because the antibiotic range may be different. In the future, these interventions can be applied to a computer program or used by clinical pharmacists.
참고문헌 (23)
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