The Development of Practice Recommendations for Drug-Disease Interactions by Literature Review and Expert Opinion.

BACKGROUND: Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence. As a consequence the translation of SmPC to clinical practice may lead to non-specific recommendations. For the translation of this information to the real world, it is necessary to evaluate the available knowledge about drug-disease interactions, and to formulate specific recommendations for prescribers and pharmacists. The aim of this paper is to describe a standardized method how to develop practice recommendations for drug-disease interactions by literature review and expert opinion. METHODS: The development of recommendations for drug-disease interactions will follow a six-step plan involving a multidisciplinary expert panel (1). The scope of the drug-disease interaction will be specified by defining the disease and by describing relevant effects of this drug-disease interaction. Drugs possibly involved in this drug-disease interaction are selected by checking the official product information, literature, and expert opinion (2). Evidence will be collected from the official product information, guidelines, handbooks, and primary literature (3). Study characteristics and outcomes will be evaluated and presented in standardized reports, including preliminary conclusions on the clinical relevance and practice recommendations (4). The multidisciplinary expert panel will discuss the reports and will either adopt or adjust the conclusions (5). Practice recommendations will be integrated in clinical decision support systems and published (6). The results of the evaluated drug-disease interactions will remain up-to-date by screening new risk information, periodic literature review, and (re)assessments initiated by health care providers. ACTIONABLE RECOMMENDATIONS: The practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published and implemented in all Clinical Decision Support Systems in the Netherlands. DISCUSSION: The recommendations result in professional guidance in the context of individual patient care. The professional will be supported in the decision making in concerning pharmacotherapy for the treatment of a medical problem, and the clinical risks of the proposed medication in combination with specific diseases.

[The NHG practice guideline 'Head injury']. / De NHG-standaard 'Hoofdtrauma'.

General practitioners frequently treat patients with head injuries. The Dutch College of General Practitioners' (NHG) practice guideline has been developed because the existing multidisciplinary guideline on head injury 'Treatment of patients with mild traumatic head/brain injury' ('Opvang patiënten met licht traumatisch hoofd/hersenletsel') is too defensive for use in primary care. The a priori probability of complications is lower in general practice than in secondary care, so selection and appraisal of risk factors for intracranial injury are different to those in the multidisciplinary guideline mentioned above. Risk factors for intracranial injury differ slightly for patients aged ≥ 16 years and for patients aged < 16 years. Use of anticoagulants--coumarin derivatives, direct oral anticoagulants, and low-molecular-weight heparin, but not thrombocyte aggregation inhibitors--is a reason for consultation with, or referral to, a specialist. Criteria for urgent referral are unconsciousness or diminished level of consciousness, focal neurological deficits, post-traumatic fits or seizures, basal skull fracture or suspicion of high-energy trauma. In the case of patients with no indication for referral, advising that the patient should be woken up at regular intervals could be included in the consultation provided written instructions were given.

[Summary of the practice guideline 'Traumatic knee problems' (first revision) from the Dutch College of General Practitioners]. / De NHG-Standaard 'Traumatische knieproblemen' (eerste herziening): samenvatting.

Most traumatic knee problems have a favourable prognosis and can be treated by the general practitioner. The course of knee symptoms and the impairment of knee function are more important for decisions about the management of knee problems than the results of physical examination of the knee. The additional value of general practitioner referral for MRI of the knee has not been established yet. Reasons for urgent referral to an orthopaedic specialist are: a knee fracture, an acutely locked knee, and a patellar dislocation.