METHODS: We conducted an intervention study in 201 community pharmacies in Belgium. On random days, patients purchasing DOACs or drugs known to interact with them were screened. When a DDI with the DOAC was detected, the pharmacist contacted the prescribing physician to discuss the management of the interaction. A previously developed practice-oriented DDI list accompanied by management plans for ambulatory care was used for both screening and management of the DDIs.
RESULTS: In total, 751 patients were included, among whom 875 DDIs were identified, primarily pharmacodynamic DDIs (95.7 %). Predominant interacting drug classes included selective serotonin or serotonin and norepinephrine reuptake inhibitors (32.9 %), antiplatelets (30.9 %), and non-steroidal anti-inflammatory drugs (28.9 %). In 43.0 % of DDIs, an intervention was decided upon. At three-month follow-up, proposed pharmacotherapy changes had been implemented in 79.1 % of these DDIs.
CONCLUSIONS: This study demonstrates that active screening and management of DDIs with DOACs in community pharmacies, in close collaboration with prescribing physicians, resulted in changes in pharmacotherapy in a substantial number of patients. This may contribute significantly to the safer utilisation of DOACs in high-risk populations.
方法:我们在比利时的201家社区药房进行了一项干预研究。在随机的日子里,筛查了购买DOAC或已知与之相互作用的药物的患者。当检测到带有DOAC的DDI时,药剂师联系了处方医生,讨论了相互作用的管理。先前开发的以实践为导向的DDI清单以及门诊护理管理计划被用于DDI的筛查和管理。
结果:总计,包括751名患者,其中确定了875个DDI,主要是药效学DDIs(95.7%)。主要的相互作用药物类别包括选择性5-羟色胺或5-羟色胺和去甲肾上腺素再摄取抑制剂(32.9%),抗血小板(30.9%),和非甾体抗炎药(28.9%)。在43.0%的DDI中,决定进行干预。在三个月的随访中,79.1%的DDI实施了拟议的药物治疗变更.
结论:本研究表明,在社区药房使用DOAC积极筛查和管理DDI,与处方医生密切合作,导致大量患者的药物治疗发生变化。这可能大大有助于在高风险人群中更安全地利用DOAC。