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PDDI Info Model Task Force - Content Sub-team minutes for 5/19

From: Richard Boyce <rdb20@pitt.edu>
Date: Fri, 20 May 2016 06:19:26 -0400
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Message-ID: <573EE4AE.7060209@pitt.edu>
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
rdb20@pitt.edu
Office: 412-648-9219
Twitter: @bhaapgh
Received on Friday, 20 May 2016 10:20:07 UTC

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