Potential Drug-Drug Interactions in the Outpatient Setting

Background: Although medication safety research has tended to focus on inpatients, the safety of drug use among outpatients is also a concern. Objective: We estimate the frequency of potentially interacting concomitant medication dispensing among outpatients. Research Design: We report the number an...

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Bibliographic Details
Published in:	Medical care Vol. 44; no. 6; pp. 534 - 541
Main Authors:	Lafata, Jennifer Elston, Schultz, Lonni, Simpkins, Jan, Chan, K. Arnold, Horn, John R., Kaatz, Scott, Long, Charron, Platt, Richard, Raebel, Marsha A., Smith, David H., Xi, Huago, Yood, Marianne Ulcickas
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins 01-06-2006 Lippincott Williams & Wilkins, Inc Lippincott Williams & Wilkins Ovid Technologies
Subjects:	Aged Cyclosporins Drug Interactions Drug prescriptions Drug therapy Drug Utilization Drug-Related Side Effects and Adverse Reactions Female Health insurance Health Maintenance Organizations Humans Insurance Coverage - utilization Insurance, Health - utilization Male Managed care Medical errors Medical practice Medications Middle Aged Muscular diseases Outpatient care facilities Outpatients - statistics & numerical data Patient safety Pharmacy Physicians Polypharmacy Prescription drugs Side effects
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Summary:	Background: Although medication safety research has tended to focus on inpatients, the safety of drug use among outpatients is also a concern. Objective: We estimate the frequency of potentially interacting concomitant medication dispensing among outpatients. Research Design: We report the number and percent of patients annually dispensed an object drug of interest (ie, warfarin, digoxin, cyclosporine, or lovastatin/simvastatin) with a potentially interacting drug among a random sample of insured adults receiving care from 10 integrated delivery systems. We use 2 definitions of concomitant dispensing: medications dispensed: 1) during the time period for which the patient had the other medication available ('days supply') and 2) on the same day. We also estimate the number of insured U. S. population codispensed these medication pairs. Results: Among patients dispensed a drug of interest, between 17.8% (95% confidence interval [CI] = 17.1-18.6%) and 28.0% (95% CI = 24.0-32.1%) were concomitantly dispensed a potentially interacting drug using the "days supply" definition, and between 7.1% (95% CI = 6.6-7.7%) and 17.7% (95% CI = 14.4-21.1%) using the "same day" definition. Extrapolating to the insured U. S. population, between 1.29 (95% CI = 1.25-1.33; same day) and 2.67 (95% CI = 2.62-2.72; days supply) million insured adults are dispensed 1 of these 4 potentially interacting pairs. Conclusions: We found evidence of potentially interacting concomitant medication dispensing among outpatients. An opportunity exists to better understand how such dispensing translates into adverse events and ultimately to improved medication safety.
ISSN:	0025-7079 1537-1948
DOI:	10.1097/01.mlr.0000215807.91798.25