Development and implementation of hdc.drapp.la and SIMDA programs to reduce polypharmacy and drug-drug interactions in patients hospitalized in Internal Medicine.

OBJECTIVE: We evaluated polypharmacy and drug-drug interactions (DDIs) in hospitalized patients before and after using the SIMDA Computerized Medical Decision Support System (CMDSS).

MATERIALS AND METHODS: We included the prescriptions of ≥18 years hospitalized patients in the Department. We developed and implemented the Hdc.DrApp Physician Order Entry System and the CMDSS SIMDA, which detects DDIs and signals dosage adjustment based on renal function. To evaluate the impact of the CMDSS, we made a comparison Before (Survey) / After (Intervention): Survey between Oct/22/2019, and Mar/21/2020, and Intervention between apr/4/2020 and sep/3/2020. We analyze prescriptions from the first day and after the first day. We compared the number of drugs, polypharmacy (5 drugs), excessive polypharmacy (10 drugs), and DDIs. We evaluated differences with the X2 test, Yates correction, Fisher's exact test, ANOVA, and post hoc tests according to their characteristics.

RESULTS: We evaluated 2,834 admissions: Survey 1,211 and Intervention 1,623. The number of drugs per patient was 6.02 (±3.20) in Survey and 5.17 (±3.22) in Intervention (p<0.001) on the first day and 9.68 (±5.60) in Survey and 7.22 (±4.93) in Intervention (p<0.001) throughout the hospitalization. Polypharmacy was present in 64% of the Survey and 53% of Interventions (RR: 0.83 (0.78-0.88); and excessive polypharmacy in 14% of the Survey and 10% of Intervention (RR: 0.73, 0.60-0.90). The frequency of total DDIs was 1.91/patient (±4.11) in Survey and 0.35 (±0.81) in the Intervention (p<0.001).

CONCLUSIONS: We developed and implemented the Hdc.DrApp and SIMDA systems that were easy to use and allowed us to quantify and reduce polypharmacy and DDIs.