Facilitators and barriers to uptake of drug-drug interaction alerts: perspectives of Australian end users and managers

Background: Drug-drug interaction (DDI) alerts in electronic systems are frequently implemented to minimize the occurrence of preventable DDIs. While prescribers recognize the potential benefits of DDI alerts, a large proportion are overridden by users. Objectives: This study aimed to explore and compare prescribers' and managers' perspectives of DDI alerts. Methods: A qualitative descriptive study was conducted across six hospitals in Australia with end users (prescribers who receive alerts) [n = 14] and managers [n = 20] (senior staff in roles relevant to alert system implementation and management). End users were asked to reflect on alert usefulness, benefits, risks, and impacts. Managers were asked what they thought of alerts, and about any feedback they had received from frontline clinicians. Key themes were extracted via an inductive content analysis approach and deductively mapped to the Technology Acceptance Model (TAM3). Comparisons of the views held toward the alerts were made between the two participant groups. Results: End users predominantly reflected on the utility of the DDI alert system (i.e. how useful it was to their role), less on how easy the system was to use, and mainly focused on the negative consequences of alerts. Managers believed the benefits of DDI alerts are primarily experienced by junior doctors. While end users suggested that alerts should be tailored to the patient's clinical scenario, managers called for DDI alerts to be tailored to the prescriber (seniority and specialty). Conclusion: Interviews with end users and managers uncovered a number of perceived benefits and limitations of DDI alerts, primarily related to the system's usefulness. While largely consistent, some perceptions were different between end users and managers, particularly in the types of benefits, and how they conceptualized potential tailoring to improve DDI alerts. Our findings point to a need for user participation in the development, deployment, and improvement of alerts to promote consideration and effectiveness of DDI alerts.