Using INTERCheck® to Evaluate the Incidence of Adverse Events and Drug-Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Antonio Martocchia; Valerio Spuntarelli; Francesco Aiello; Anna Laura Meccariello; Maria Proietta; Flavia Del Porto; Roberta Di Rosa; Simonetta Salemi; Massimiliano Rocchietti March; Bruno Laganà; Paolo Martelletti; Giorgio Sesti

doi:10.1007/s40801-020-00193-9

Using INTERCheck^® to Evaluate the Incidence of Adverse Events and Drug-Drug Interactions in Out- and Inpatients Exposed to Polypharmacy

Drugs Real World Outcomes. 2020 Sep;7(3):243-249. doi: 10.1007/s40801-020-00193-9.

Affiliations

¹ Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy. a_martocchia@virgilio.it.
² Internal Medicine, S.Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.

Abstract

Background: Polypharmacy exposes patients with comorbidities (particularly elderly patients) to an increased risk of drug-specific adverse events and drug-drug interactions. These adverse events could be avoided with the use of a computerized prescription support system in the primary care setting. The INTERCheck^® software is a prescription support system developed with the aim of balancing the risks and benefits of polytherapy and examining drug-drug interactions.

Objectives: This observational study used the INTERCheck^® software to evaluate the incidence of adverse events and of drug-drug interactions in outpatients and inpatients receiving multiple medications.

Methods: Patients were randomly enrolled from the outpatient department (n = 98) and internal medicine ward (n = 46) of S. Andrea Hospital of Rome. Polypharmacological treatment was analyzed using INTERCheck^® software, and the prevalence of risk indicators and adverse events was compared between the two groups.

Results: Polypharmacy (use of five or more drugs) applied to all except three cases among outpatients and one case among inpatients. A significant positive correlation was found between the number of medications and the INTERCheck^® score (ρ = 0.67; p < 0.000001), and a significant negative correlation was found between the drug-related anticholinergic burden and cognitive impairment (r = - 0.30 p = 0.01). Based on the INTERCheck^® analysis, inpatients had a higher score for class D (contraindicated drug combination should be avoided) than did outpatients (p = 0.01). The potential class D drug-drug interactions were associated with adverse events that caused hospitalization (χ² = 7.428, p = 0.01).

Conclusions: INTERCheck^® analysis indicated that inpatients had a high risk of drug-drug interactions and a high percentage of related adverse drug events. Further prospective studies are necessary to evaluate whether the INTERCheck^® software may help reduce polypharmacy-related adverse events when used in a primary care setting and thus potentially avoid related hospitalization and severe complications such as physical and cognitive decline.