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CLINICAL RELEVANCE OF PHARMACOLOGIC INTERACTIONS

This study investigates the incidence and risk of hospitalization due to adverse events caused by drug interactions in Austria. Results show that certain combinations of statins, benzodiazepines, macrolide antibiotics, and amiodarone have a significant impact on hospitalization rates. The findings support the importance of implementing e-medication systems to prevent prescription errors and improve patient safety.

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CLINICAL RELEVANCE OF PHARMACOLOGIC INTERACTIONS

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  1. CLINICAL RELEVANCE OF PHARMACOLOGIC INTERACTIONS Gottfried ENDEL a,, Kurt NEUMANNbc, Roland N. BOUBELAc, Klaudius KALCHERc ,Gerfried NELLd a Hauptverband der Österreichischen Sozialversicherungsträger b VISEM  -  Vienna School of Evidence Based Medicine c Department of Statistics and Probability Theory – Vienna University of Technology d Nell Pharma Connect Ltd

  2. RESEARCH QUESTION • Question one is the incidence of combinations of substances with a potential of interaction out of 4 ATC groups • Question two tries to quantify the risk of hospitaliSation due to ADVERSE EVENTS (ICD10 T36 - T46) these interactions. Dr. Gottfried Endel STC2010

  3. PHARMACOLOGICAL INTERACTION • LITERATURE AND EVIDENCE EXIST • BUT NO DATA FOR AUSTRIA • INVESTIAGTIGATION OF CYP 450 INTERACTIONS • http://medicine.iupui.edu/clinpharm/DDIs/table.asp • http://www.hauptverband.at/mediaDB/671829_ISPOR,%20Atlanta,%202010%20-%20Clinical%20Relevance%20of%20Pharmacological%20Interactions.pdf Dr. Gottfried Endel STC2010

  4. RESULTS K1 Statins and macrolid antibiotics D+C K2 Statins and benzodiazepines D+B K3 Statins and amiodarone D+A K4 Benzodiazepines and macrolide antibiotics B+C K5 Benzodiazepines and amiodarone B+A KG1 benzodiazepins alone B KG2 statins alone D OTHER MEDICATION WAS NOT EXAMINED! Dr. Gottfried Endel STC2010

  5. RESULTS Dr. Gottfried Endel STC2010

  6. RESULTS Dr. Gottfried Endel STC2010

  7. RESULTS Dr. Gottfried Endel STC2010

  8. RESULTS • ANSWER ONE: IN 2006 AND 2007 A TOTAL OF 234490 PERSONS ( 2.8% OF THE POPULATION!)WERE EXPOSED TO ONE OF THE PHARMACEUTICAL INTERACTIONS Dr. Gottfried Endel STC2010

  9. RESULTS • ANSWER TWO: THE RELATIV RISK INCREAS IS IN GROUP K2 230% OND IN K3 187%; SO THE NUMBER NEEDED TO HARM IS 1393 AND 1742! COMBINATIONS WITH MACROLIDS DO NOT INCREASE THE RISK FOR THEESE OUTCOMES Dr. Gottfried Endel STC2010

  10. RESULTS OUTCOME MEASUREMENT HOSPITALISATIONS ARE SERIOUS EVENTS FOR PATIENTS. SO WE DECIDED TO QUALIFY HOSPITALISATIONS WITH CERTAIN MAIN DIAGNOSES FOLLOWING AN EXPOSURE TO A PRESCRIPTION ERROR AS OUTCOME. E-HEALTH ELECTRONIC DATA ENTRY SYSTEMS FOR PHARMACEUTICAL PRESCRIPTIONS ALLOW A TECHNICAL CONTROL OF THE WHOLE MEDICATION OF A PATIENT USING INTERACTION DATABASES. SUCH e-MEDICATION SYSTEMS ARE A MANDATORY PART OF EVERY ELECTRONIC HEALTH RECORD SYSTEM. AS TO BUILD AND MAINTAIN AN EHR IS EXPENSIVE IT IS NECESSARY TO QUANTIFY POTENTIAL BENEFITS. Dr. Gottfried Endel STC2010

  11. LIMITATIONS • CODING OF THE MAIN DIAGNOSES IN A DRG SYSTEM MAY NOT ALLWAYS REPRESENT THE BEST FIT DIAGNOSE. SO WE ALSO WILL EXAMINE THE CORRELATION TO SECONDARY DIAGNOSES. • FOR CLINICAL QUESTIONS AGE AND GENDER OF PATIENTS AND ALL OTHER PHARMACEUTICALS REIMBURSED IN THE TIME OF INTEREST HAVE TO BE LOOKED AT. Dr. Gottfried Endel STC2010

  12. CONCLUSION • BASE LINE DATA FOR MEASURING THE EFFECTS OF E-MEDICATION CAN BE DERIVED FROM REIMBURSEMENT DATA • MODELS FOR COST / EFFECTIVNESS OF E-MEDICATION ARE POSSIBLE AFTER THE PILOT PERIODE FURTHER INFORMATION WWW.HAUPTVERBAND.AT/EBM_HTA Dr. Gottfried Endel STC2010

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