Hi, the minutes and link to meeting recording for the May 19th meeting
of the content sub-team of the PDDI Info Model Task Force are pasted
below. Kind regards, -R
Minutes for 5/19/2016 (Content subgroup)
In Attendance: Evan Draper, Brian LeBaron, Richard Boyce, Dan Malone,
John Poikonen, Michel Dumontier, Scott Nelson, Jeff Nielsen, Serkan
Ayvaz, John Horn, Elizabeth Garcia, Louisa Zhang
Meeting recording:http://goo.gl/lESwy5
Meeting:
*
Introductions
*
Refresher from last meeting
o
Agreeing on interactions to work on
o
Decision trees for certain interactions
*
Decision Trees
o
Beta blocker+Epinephrine, Warfarin-NSAIDs; K-sparing
diuretics/KCl just added
o
Goal is to create decision trees for selected interactions that
identify clinical consequences, patient factors, specific drugs
involved, specific actions to take
o
Qualtrics survey sent to Standards Team; results pending
+
User-centered definition of clinical consequence
o
Beta blocker+Epinephrine and Warfarin+NSAIDs decision trees
*
Discussion of Suggested DDIs
o
4 additional PDDIs were agreed upon:https://goo.gl/rYpmjt
o
Several categories were discussed in depth
o
Evidence supporting the interaction is weak
+
Citalopram+Amiodarone interaction will be removed
#
In the case of citalopram+ amiodarone, there is a lot of
evidence, but there is little risk associated with the
combination
+
Warfarin + antibiotics that don’t inhibit CYP2C9 is a much
better example of weak evidence
+
Distinction between two separate ideas:
#
1 – Trying to identify if there is a problem with a drug
pair
*
Most interactions don’t have good evidence
#
2 – People have studied it, but is there an increased
risk of harm?
*
Not in the case of Citalopram+Amiodarone
+
What exactly are we talking about in terms of “evidence
supporting the interaction”
#
Different answers based on different questions
*
Is there a potential interaction? Yes
*
Is there a clinically important/pharmacodynamic
interaction? No
*
Is there a potential kinetic interaction? Yes, but
we don’t know if there’s evidence of it
+
Question of scoping – is this model/are these examples
focusing on things with clinical effects, or is it broader?
#
What about pharmacokinetic effects? What about what
patients are interested in?
+
Needs further thought
o
Mechanism is not known
+
Warfarin + fibrates: does not necessarily apply for the
class; removed
+
Pravastatin + paroxetine: issue of potentially spurious
relationship based on data mining; removed
o
Frequency of exposure is/is not available
o
Frequency of adverse effects is/is not available
+
Discussion about definitions of “frequency” and “exposure”
#
What is the purpose of including these as information items?
*
If we keep the frequency is/is not available
categories in, they will allow us to fill in gaps
with our datasets
+
Really depends on your numerator and denominator
#
Defining the populations; depending on source, you can
get lots of different information
+
How do you define when exposure matters?
#
Can we define a cohort of patients, and what kind of
exposure matters (when, where, under what setting)?
+
Not a straightforward set of categories; need to define further
+
Pharmacy Quality Alliance (PQA) <http://pqaalliance.org/>–
quality measures at health system level; creating a list of
drug interactions of concern based on large claims database
#
Not included in the list of our stakeholders (focused on
researchers, drug compendia editors)
*
Should we include this stakeholder group?
#
Needs further discussion
*
Next Steps
o
Will send out several more questionnaires to move things forward
+
Stakeholder descriptions
+
Drug interaction categories
o
Need to define evidence
+
Absence of evidence vs. evidence showing lack of clinical
relevance
+
Kinetic interaction vs. interaction requiring clinical
intervention
o
Frequency of exposure data and adverse event data
+
Defining for the minimum information model
+
Their purpose as information items
o Consider health service quality measures vs. clinically-oriented
concerns
--
Richard D Boyce, PhD
Assistant Professor of Biomedical Informatics
Faculty, Center for Pharmaceutical Policy and Prescribing
Faculty, Geriatric Pharmaceutical Outcomes and Gero-Informatics Research and
Training Program
University of Pittsburgh
rd...@pitt.edu
Office: 412-648-9219
Twitter: @bhaapgh
