title: Inter-rater agreement among physicians on the clinical significance of drug-drug interactions.
abstract: BACKGROUND
  Alert fatigue could potentially be improved if physicians agreed on which alerts were clinically significant. We conducted a study to determine the extent to which physicians agree on which drug-drug interactions are clinically significant.
  
  
  METHODS
  Two groups of eight generalist physicians reviewed 100 randomly selected drug-drug interactions from the Medi-Span® Drug Therapy Monitoring System™ database and indicated whether they thought each interaction was clinically significant based on the full-text clinical discussion contained within each interaction monograph and their clinical experience.
  
  
  RESULTS
  The Fleiss Kappa measure of inter-rater agreement was 0.19 (0.12, 0.26) for one group, 0.22 (0.14, 0.29) for the second group and 0.21 (0.15, 0.27) for the combined group.
  
  
  CONCLUSIONS
  We found poor agreement among generalist physicians on which drug-drug interactions are clinically significant. Use of a feature to allow physicians to tailor alerts to their needs may be an important component in reducing alert fatigue.
authors.affiliation: Wolters Kluwer Health, Indianapolis, IN.
authors.forename: Howard R
authors.initials: HR
authors.lastname: Strasberg
authors.affiliation: Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Albert
authors.initials: A
authors.lastname: Chan
authors.affiliation: Wolters Kluwer Health, Indianapolis, IN.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sklar
mesh_terms: D001291:Attitude of Health Personnel; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D050316:Medical Order Entry Systems; D058007:Physicians, Primary Care; D017010:Reminder Systems