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How is it that pharmacies still aren’t checking for drug-drug interactions?

How is this still a thing? How is it that pharmacists routinely aren't checking for drug-drug interactions?

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How is this still a thing?

How is it that pharmacists routinely aren’t checking for drug-drug interactions, given that 77 percent of outpatient prescriptions were sent electronically in 2015.

The Chicago Tribune reported Thursday — and in its Sunday print edition — that 52 percent of Illinois pharmacies it tested did not mention potentially dangerous interactions when filling pairs of prescriptions known to carry such risks.

The Tribune reporter walked into an Evanston CVS pharmacy carrying two prescriptions: one for a common antibiotic, the other for a popular anti-cholesterol drug.

Taken alone, these two drugs, clarithromycin and simvastatin, are relatively safe. But taken together they can cause a severe breakdown in muscle tissue and lead to kidney failure and death.

When the reporter tried to fill the prescriptions, the pharmacist should have warned him of the dangers. But that’s not what happened. The two medications were packaged, labeled and sold within minutes, without a word of caution.

The same thing happened when a reporter presented prescriptions for a different potentially deadly drug pair at a Walgreens on the Magnificent Mile [in Chicago].

And at a Wal-Mart in Evergreen Park, a Jewel-Osco in River Forest and a Kmart in Springfield.

Independent pharmacies fared worse than the big chains; 72 percent of those the Tribune tested neglected to warn the reporter/patient about an interaction and didn’t bother contacting the prescribing physician. CVS, Target, Kmart and Costco all had failure rates of at least 60 percent, though the Tribune stopped testing at Target in its two-year investigation after CVS took over pharmacy operations in Target stores a year ago last week.

Walgreens did best, at 30 percent, followed by local supermarket chain Mariano’s at 37 percent. However, a Mariano’s statement was somewhat defiant. “None of our pharmacists are intentionally disregarding drug interactions or patient safety,” the statement said, according to the Tribune. “Our pharmacists look at each patient profile which includes patient history, allergy profile, pre-existing conditions and other factors such as age, all of which must be considered when assessing the potential for a drug interaction.”

Even 30 percent is far too high of a failure rate, given how many scripts now come in electronically, and the big, national chains know it. “In response to the Tribune tests, CVS, Walgreens and Wal-Mart each vowed to take significant steps to improve patient safety at its stores nationwide,” the Tribune said.

In a follow-up story Monday, the Tribune reported that the National Association of Boards of Pharmacy now wants tougher state laws regulating the behavior of pharmacists. “Counseling has to occur,” NABP Executive Director Carmen Catizone was quoted as saying.

In Illinois, pharmacies are only required to ask patients if they want counseling. Sometimes this request is as simple as, “Any questions?” according to the Tribune. There does not have to be a mention of potentially harmful interactions.

According to the story, Catizone would like to see public reporting to states of medication errors that occur at pharmacies. He also called for research into whether states should set minimum pharmacy staffing levels.

In light of the investigation, Sen. Dick Durbin (D-Illinois) advocated for national policies about drug interaction checking.

“It’s hard for me to believe that, in this age of computers and software, we would still be dealing with such a fundamentally dangerous issue,” Durbin told the Chicago newspaper. “You would think that, at this point, with records being kept and the vast amount of knowledge on these drugs, the pharmacists could wave off prescriptions that are dangerous to customers.”

Yes, you would think. But healthcare, for some reason, still hasn’t fully made it into the 21st Century.

Photo: Flickr user Shawn Rossi

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