Exposure to Automated Drug Alerts Over Time: Effects On Clinicians’ Knowledge And Perceptions

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Abstract

Objective:

We tested whether interval exposure to an automated drug alert system that included approximately 2000 drug–drug interaction alerts increased recognition of selected interacting drug pairs. We also examined other perceptions about computerized order entry.

Research Design:

We administered cross-sectional surveys in 2000 and 2002 that included more than 260 eligible clinicians in each time period.

Subjects:

We studied clinicians practicing in ambulatory settings within a Southern California Veterans Affairs Healthcare System and who responded to both surveys (97 respondents).

Measures:

We sought to measure (1) recognition of selected drug–drug and drug–condition interactions and (2) other benefits and barriers to using automated drug alerts.

Results:

Clinicians correctly categorized similar percentages of the 7 interacting drug–drug pairs at baseline and follow-up (53% vs. 54%, P = 0.51) but improved their overall recognition of the 3 contraindicated drug–drug pairs (51% vs. 60%, P = 0.01). No significant changes from baseline to follow-up were found for the 8 interacting drug–condition pairs (60% vs. 62%, P = 0.43) or the 4 contraindicated drug–condition pairs (52% vs. 56%, P = 0.24). More providers preferred using order entry at follow-up than baseline (63% vs. 45%, P < 0.001). Signal-to-noise ratio remained the biggest reported problem at follow-up and baseline (54 vs. 57%, P = 0.75). In 2002, clinicians reported seeing a median of 5 drug alerts per week (representing approximately 12.5% of prescriptions entered), with a median 5% reportedly leading to an action.

Conclusions:

Interval exposure to automated drug alerts had little to no effect on recognition of selected drug–drug interactions. The primary perceived barrier to effective utilization of drug alerts remained the same over time.

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