May 2006

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Context. At Partners Health Care System, drug drug interaction (DDI) alerts are presented at three levels of severity to clinicians at the time of ordering medications. Objective. Describe the most frequent DDI alerts, and clinician acceptance rates according to severity level, drug pair, drug family, and patient demographics. Design. Descriptive, retrospective analysis of all DDI alerts during a one year period. Setting. Ambulatory clinics that use Partners' DDI checking services. Participants.All adult patient visits in which a DDI alert occurred were included. Interventions. A Level 1 DDI requires the clinician to remove one or both drugs from the patient's medication list. A level 2 alert allows the clinician to keep both, but requires the clinician to provide a reason. A Level 3 DDI is displayed as information only, requiring no action from the clinician. Main Outcome Measures. Number of alerts generated at each severity level; percentage of each by age, gender, and race; and acceptance rates for Level 2 interruptible alerts by individual drug pair and class. Results. Acceptance of recommendations occurs in just under half of all Level 2 DDI alert warnings. A review of literature supports, in general, the inclusion of the interventions we have in our knowledge base. In some instances the literature does not agree, which may provide clues to clinician non-acceptance of alerts. Conclusion. Presenting DDI alerts with varying options according to severity level reduces the number of interruptible alerts during the prescribing session, encouraging clinicians to make informed, clinically appropriate, decisions.




School of Medicine



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