J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 11, November 2018, pages 806-814

Drug-Drug Interaction Assessment and Identification in the Primary Care Setting

**Table 1.** Baseline Provider Characteristics, Self-Reported
	N = 330
Male	76.7%
Age
< 40	6.4%
40 - 55	60.9%
> 55	32.7%
Board certification
Family medicine	49.1%
Internal medicine	49.7%
Both	1.2%
Fellowship	14.6%
Years in practice	20.1 ± 6.9
Region
Midwest	22.7%
Northeast	25.5%
South	30.9%
West	20.9%
Locale
Urban	26.7%
Suburban	60.9%
Rural	12.4%
Practice type
Solo private	23.3%
Single specialty private	37.6%
Multi-specialty private	33.0%
Hospital	6.1%
Employed by practice (%)	74.6%
Multi-specialty practice	32.7%
Medical practice setting (can choose more than one)
Accountable care organization	24.2%
Solo practice	23.3%
Group practice	66.4%
Hospital-based	8.2%
Integrated delivery system	11.5%
Network model HMO	1.2%
Staff-model HMO (employed)	1.2%
Staff-model HMO (FFS or group, contracted)	1.2%
Other	1.8%
Type of medication reconciliation used (physicians were able to choose > 1 )
Pharmacy/medication reconciliation	88.2%
Presumptive drug tests	57.3%
Definitive drug tests	37.3%
Digital pills	0.0%
Self-report	62.7%
EMR/automated software	74.6%
None	1.0%
Time since last CME in pain management
≤ 12 months	41.5%
13 - 24 months	17.0%
25 - 36 months	9.7%
> 36 months	10.9%
Never taken	20.9%
Receive quality bonus	59.7%
If yes, metrics for preventive measures	88.8%
Active panel size	2,542 ± 1,526
Patient panel characteristics
On 5 or more medications	41.2%
On opioid analgesics	13.9%
Consume ≥ 2 alcoholic beverages/month	55.4%
Payer type
Medicare	34.3%
Medicaid	10.8%
Commercial	48.1%
Self	5.4%
Other	1.4%

Table 1. Baseline Provider Characteristics, Self-Reported

N = 330

Male

76.7%

Age

< 40

6.4%

40 - 55

60.9%

> 55

32.7%

Board certification

Family medicine

49.1%

Internal medicine

49.7%

Both

1.2%

Fellowship

14.6%

Years in practice

20.1 ± 6.9

Region

Midwest

22.7%

Northeast

25.5%

South

30.9%

West

20.9%

Locale

Urban

26.7%

Suburban

60.9%

Rural

12.4%

Practice type

Solo private

23.3%

Single specialty private

37.6%

Multi-specialty private

33.0%

Hospital

6.1%

Employed by practice (%)

74.6%

Multi-specialty practice

32.7%

Medical practice setting (can choose more than one)

Accountable care organization

24.2%

Solo practice

23.3%

Group practice

66.4%

Hospital-based

8.2%

Integrated delivery system

11.5%

Network model HMO

1.2%

Staff-model HMO (employed)

1.2%

Staff-model HMO (FFS or group, contracted)

1.2%

Other

1.8%

Type of medication reconciliation used (physicians were able to choose > 1 )

Pharmacy/medication reconciliation

88.2%

Presumptive drug tests

57.3%

Definitive drug tests

37.3%

Digital pills

0.0%

Self-report

62.7%

EMR/automated software

74.6%

None

1.0%

Time since last CME in pain management

≤ 12 months

41.5%

13 - 24 months

17.0%

25 - 36 months

9.7%

> 36 months

10.9%

Never taken

20.9%

Receive quality bonus

59.7%

If yes, metrics for preventive measures

88.8%

Active panel size

2,542 ± 1,526

Patient panel characteristics

On 5 or more medications

41.2%

On opioid analgesics

13.9%

Consume ≥ 2 alcoholic beverages/month

55.4%

Payer type

Medicare

34.3%

Medicaid

10.8%

Commercial

48.1%

Self

5.4%

Other

1.4%

**Table 2.** CPV Results
CPV domain
Overall	50.5 ± 12.0%
History	64.6 ± 14.1%
Physical	79.2 ± 24.8%
Workup	54.9 ± 41.3%
Diagnosis-Treatment	22.9 ± 16.9%
Ordered pharmacy medication reconciliation	5.6%
Ordered presumptive or definitive drug test	44.7%
Primary diagnosis
Identified medical problem	55.1%
Identified drug-drug interaction	15.3%
Identified specific drug-drug interaction	0.9%
Secondary diagnosis	52.9%
Preventive measures
Screening for cancer	5.0%
Advised drug-drug interaction	5.6%
Counseled on smoking cessation	14.6%
Coordinate medications with all patient providers	16.4%
Referral to psychiatrist	46.6%
Referral to pain specialist	22.4%
Number of low-value diagnostic workup ordered, per case	0.8 ± 1.1
Cost of low-value diagnostic workup ordered, per case	$121 ± $195
Unnecessary measures
Referral to neurology	9.9%
Inappropriate admission to the hospital	0.0%

Table 2. CPV Results

CPV domain

Overall

50.5 ± 12.0%

History

64.6 ± 14.1%

Physical

79.2 ± 24.8%

Workup

54.9 ± 41.3%

Diagnosis-Treatment

22.9 ± 16.9%

Ordered pharmacy medication reconciliation

5.6%

Ordered presumptive or definitive drug test

44.7%

Primary diagnosis

Identified medical problem

55.1%

Identified drug-drug interaction

15.3%

Identified specific drug-drug interaction

0.9%

Secondary diagnosis

52.9%

Preventive measures

Screening for cancer

5.0%

Advised drug-drug interaction

5.6%

Counseled on smoking cessation

14.6%

Coordinate medications with all patient providers

16.4%

Referral to psychiatrist

46.6%

Referral to pain specialist

22.4%

Number of low-value diagnostic workup ordered, per case

0.8 ± 1.1

Cost of low-value diagnostic workup ordered, per case

$121 ± $195

Unnecessary measures

Referral to neurology

9.9%

Inappropriate admission to the hospital

0.0%

**Table 3.** Logistic Regression to Identify a Potentially Harmful DDI
	OR	P-value	95% CI lower	95% CI upper
Male	0.99	0.957	0.64	1.53
Age < 40	0.94	0.881	0.43	2.06
South	1.36	0.119	0.92	2.01
Internal medicine	1.06	0.751	0.73	1.55
Hospital-based practice	1.30	0.482	0.62	2.73
Medical reconciliation tools used > 5	1.27	0.327	0.79	2.05
More than 35% of patients with 5+ medications	1.14	0.513	0.76	1.72
Less than 10% of patients on opioids for pain	1.32	0.169	0.89	1.95
Asks about history of medications	1.64	0.028	1.05	2.54
Ordering a definitive drug test	1.62	0.013	1.11	2.36
CPV patient on psychiatric medications	3.74	0.000	2.56	5.45
CPV patient with polypharmacy/alcohol	0.65	0.037	0.43	0.97
Constant	0.04	0.000	0.02	0.09

Table 3. Logistic Regression to Identify a Potentially Harmful DDI

P-value

95% CI lower

95% CI upper

Male

0.99

0.957

0.64

1.53

Age < 40

0.94

0.881

0.43

2.06

South

1.36

0.119

0.92

2.01

Internal medicine

1.06

0.751

0.73

1.55

Hospital-based practice

1.30

0.482

0.62

2.73

Medical reconciliation tools used > 5

1.27

0.327

0.79

2.05

More than 35% of patients with 5+ medications

1.14

0.513

0.76

1.72

Less than 10% of patients on opioids for pain

1.32

0.169

0.89

1.95

Asks about history of medications

1.64

0.028

1.05

2.54

Ordering a definitive drug test

1.62

0.013

1.11

2.36

CPV patient on psychiatric medications

3.74

0.000

2.56

5.45

CPV patient with polypharmacy/alcohol

0.65

0.037

0.43

0.97

Constant

0.04

0.000

0.02

0.09

**Table 4.** Performing Any DDI-related Treatment
	OR	P-value	95% CI lower	95% CI upper
Male	0.73	0.066	0.52	1.02
Age < 40	0.95	0.859	0.52	1.71
South	1.17	0.325	0.86	1.58
Internal medicine	0.86	0.324	0.65	1.15
Hospital-based practice	2.59	0.002	1.41	4.76
Medical reconciliation tools used ≥ 5	0.90	0.600	0.61	1.33
More than 35% of patients with 5+ medications	0.99	0.953	0.73	1.35
Less than 10% of patients on opioids for pain	1.12	0.462	0.83	1.51
Asks about history of medications	1.04	0.821	0.76	1.42
Ordering a definitive drug test	1.51	0.006	1.13	2.02
Identified a drug-drug interaction exists	3.32	0.000	2.21	4.99
CPV patient on psychiatric medications	1.86	0.000	1.36	2.53
CPV patient with polypharmacy/alcohol	0.25	0.000	0.18	0.34
Constant	0.70	0.193	0.41	1.20

Table 4. Performing Any DDI-related Treatment

P-value

95% CI lower

95% CI upper

Male

0.73

0.066

0.52

1.02

Age < 40

0.95

0.859

0.52

1.71

South

1.17

0.325

0.86

1.58

Internal medicine

0.86

0.324

0.65

1.15

Hospital-based practice

2.59

0.002

1.41

4.76

Medical reconciliation tools used ≥ 5

0.90

0.600

0.61

1.33

More than 35% of patients with 5+ medications

0.99

0.953

0.73

1.35

Less than 10% of patients on opioids for pain

1.12

0.462

0.83

1.51

Asks about history of medications

1.04

0.821

0.76

1.42

Ordering a definitive drug test

1.51

0.006

1.13

2.02

Identified a drug-drug interaction exists

3.32

0.000

2.21

4.99

CPV patient on psychiatric medications

1.86

0.000

1.36

2.53

CPV patient with polypharmacy/alcohol

0.25

0.000

0.18

0.34

Constant

0.70

0.193

0.41

1.20