Many doctors ignore medication safety alerts

Secret Ally

Does your doctor suffer from “alert fatigue”?

If so, you might want to call in a second opinion from a secret ally.

Red flags ignored

To answer the question above: yes. There’s a pretty good chance your doc has come down with a bad case of alert fatigue.

As the name implies, this condition is caused by a relentless barrage of medication safety alerts that often pop up when a doctor uses an electronic prescribing system that has a feature called “decision support.” If a prescribed drug is known to interact poorly (or dangerously) with another medication prescribed to the patient, the system alerts the doctor.

Then what do you suppose the doctor does?

A research team from a diverse group of U.S. research centers set out to answer that question by examining the actions taken on more than 233,000 safety alerts issued to nearly 2,900 doctors who wrote about 3.5 electronic prescriptions over nine months. The results are disturbing:

• Doctors disregarded and followed through with the prescriptions anyway in more than 90 percent of the alerts
• Doctors disregarded more than 75 percent of the drug allergy alerts
• Most amazing: Among high-severity interaction alerts, as many as 67 to 97 percent were disregarded, depending on different classes of interacting medications

The guy behind the counter

Clearly, you can’t assume your doctor is looking out for you when it comes to drug interaction safety. But you have an ally you can call on to help navigate the pitfalls of using multiple drugs, and even drug interactions with supplements.

Did your doctor ignore a high-severity interaction alert? Put the question to your pharmacist. Not only can he quickly find the answer, but he’s also educated in drug side effects, proper dosage, generic brands, etc.

Some states actually allow pharmacists to prescribe drugs from an approved list, or from a doctor’s diagnosis, and over the next few years more states are expected to follow suit. But this shift in the doctor/pharmacist relationship has already brought the sharks circling. According to Pharmacy Times, “[Drug] companies that do not incorporate a marketing strategy involving pharmacists will lose advantage in the coming years.”

So while your pharmacist is a source of invaluable information, remember that – like your doctor – he may be feeling the same influence of a tempting pitch (with perks) from a drug salesperson.

Sources:
“Overrides of Medication Alerts in Ambulatory Care” Archives of Internal Medicine, Vol. 169, No. 3, 2/9/09, archinte.ama-assn.org
“Docs Override Most Electronic Drug Warnings” Robert Preidt, HealthDay News, 2/12/09, healthday.com
“It’s Coming: Pharmacists Prescribing Drugs” Pharmacy Times, February 2008, pharmacytimes.com