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Editor's Correspondence
July 27, 2009

Consider the Content of Drug-Drug Interaction Alerts

Arch Intern Med. 2009;169(14):1336-1340. doi:10.1001/archinternmed.2009.225

Isaac et al1 suggest ways to improve the utility of alerts in clinical systems, notably drug-drug interaction (DDI) alerts. We would add that it is also important to consider the content of the alerts—does the information provided to clinicians actually help them make decisions?

We recently undertook a study of DDI alerts in 9 primary care (general practice and community pharmacy) clinical systems in Australia to assess the presence, content, and language of the alerts.2 The study expert panel recommended that the components of information that are useful for clinical decision making include the following: clinical effects, time frame (onset and/or duration), pharmacological mechanism, and management advice. We assessed 20 clinically significant and 20 clinically unimportant interactions in each system. For the clinically significant interactions, only 2 of 9 systems provided adequate information about clinical effects for more than half of the interactions, and only 1 system described the pharmacological mechanism for more than half the interactions. Little or no information about time frame was provided. Overall, the software systems did not provide useful management advice; most provided no advice or advice considered only “somewhat useful.” In some cases, the language used in the alerts lacked clarity and occasionally was difficult to comprehend. Some systems used unhelpful phrases such as “use with caution.” In response to these findings, we have made specific recommendations on the content, format, and language of DDI alerts.2