title: Clarity and applicability of drug-drug interaction management guidelines: a systematic appraisal by general practitioners and community pharmacists in the Netherlands.
abstract: BACKGROUND
  Despite the availability and daily use of computerized drug-drug interaction surveillance systems, exposure to potentially relevant drug-drug interactions (DDIs) continues. DDI management guidelines are often inadequate and clear management options are lacking, which attributes to overriding of DDI signals. Although general criteria for the development and reporting of high-quality clinical practice guidelines have been identified, it appears these have not yet been applied to DDI management guidelines.
  
  
  OBJECTIVE
  The aim of the study was to assess the clarity and applicability of guidelines for the management of potentially harmful DDIs.
  
  
  METHODS
  We selected 13 DDIs that are potentially harmful for patients and frequently occur in community pharmacy practice in the Netherlands. The clarity and applicability of the management guidelines of these DDIs were appraised using the appropriate two domains - 'Clarity and presentation' and 'Applicability', of the validated Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. The appraisal was performed by 12 community pharmacists and 12 general practitioners. The standardized domain scores and mean item scores for 'Clarity and presentation' and 'Applicability' were compared.
  
  
  RESULTS
  All DDI management guidelines were generally found to score well on 'Clarity and presentation', but poorly with respect to 'Applicability' (standardized domain scores 68.0 vs 26.1%). Within the domain 'Clarity and presentation', the item 'tools for application' received the lowest scores. Within the domain 'Applicability', cost implications, organizational barriers and key review criteria were all poorly documented. All guidelines presented non-directive advice using words such as 'consider' and 'regularly'.
  
  
  CONCLUSIONS
  Developers of DDI management guidelines should take the appropriate domains of the AGREE Instrument into consideration in their development processes. The applicability of DDI management guidelines should be pretested before publishing. To improve guideline quality, more attention should particularly be paid to the available tools for applications and cost implications.
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands. a.floor@stevenshof.nl
authors.forename: Annemieke
authors.initials: A
authors.lastname: Floor-Schreudering
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
authors.forename: Henk
authors.initials: H
authors.lastname: Buurma
authors.forename: Sonia
authors.initials: S
authors.lastname: Amini
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000191:economics / Q000592:standards*; D003157:Community Pharmacy Services / Q000592:standards / Q000706:statistics & numerical data*; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D009426:Netherlands; D010595:Pharmacists / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011786:Quality Control