Recommendations for selecting drug-drug interactions for clinical decision support.

Recommendations for selecting drug-drug interactions for clinical decision support.
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为临床决策支持选择药物相互作用的建议。

DOI:
10.2146/ajhp150565
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发表时间:
2016-04-15
期刊:
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
影响因子:
--
通讯作者:
Malone DC
Malone DC
中科院分区:
其他
文献类型:
--
作者:
Tilson H;Hines LE;McEvoy G;Weinstein DM;Hansten PD;Matuszewski K;le Comte M;Higby-Baker S;Hanlon JT;Pezzullo L;Vieson K;Helwig AL;Huang SM;Perre A;Bates DW;Poikonen J;Wittie MA;Grizzle AJ;Brown M;Malone DC

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推荐将药物相互作用 (DDI) 纳入临床决策支持的原则。举办了一系列会议以改进 DDI 的临床决策支持 (CDS)。从 2013 年 1 月到 2014 年 2 月,内容工作组每月召开一次网络研讨会,并举行两次现场会议以达成共识。该工作组由来自学术界、政府机构、健康信息 (IT) 供应商和医疗保健组织的 20 名药理学、药物信息和 CDS 领域的专家组成。工作组成员讨论了四个关键问题:(1) 应使用什么流程来开发和维护一套标准的 DDI? (2) 标准 DDI 知识库中应包含哪些信息? (3) 是否可以/应该建立禁忌药对清单? (4) 如何更智能地过滤 DDI 警报?为了在美国制定和维护 CDS 的一套标准 DDI,我们建议采用透明、系统和证据驱动的流程,并由专家共识小组提出分级建议并由国家组织监督。我们概述了帮助指导临床医生决策所需的关键 DDI 信息。我们建议明智地将 DDI 分类为禁忌,因为只有一小部分药物组合是真正禁忌的。最后,我们建议进行更多研究,以确定安全减少重复和不太相关的警报的方法。选择用于提醒临床医生的 DDI 需要一个系统化的持续流程。我们预计我们的建议可以为中断性 DDI 提供一致且临床相关的内容,从而减少警觉疲劳并提高患者安全。
To recommend principles for including drug-drug interactions (DDIs) in clinical decision support. A conference series was conducted to improve clinical decision support (CDS) for DDIs. The Content Workgroup met monthly by webinar from January 2013 to February 2014, with two in-person meetings to reach consensus. The workgroup consisted of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information (IT) vendors, and healthcare organizations. Workgroup members addressed four key questions: (1) What process should be used to develop and maintain a standard set of DDIs?; (2) What information should be included in a knowledgebase of standard DDIs?; (3) Can/should a list of contraindicated drug pairs be established?; and (4) How can DDI alerts be more intelligently filtered? To develop and maintain a standard set of DDIs for CDS in the United States, we recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated, as only a small set of drug combinations are truly contraindicated. Finally, we recommend more research to identify methods to safely reduce repetitive and less relevant alerts. A systematic ongoing process is necessary to select DDIs for alerting clinicians. We anticipate that our recommendations can lead to consistent and clinically relevant content for interruptive DDIs, and thus reduce alert fatigue and improve patient safety.
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