Drug–Drug Interactions in Outpatient Private Clinic Settings vs. Hospital Settings: A Systematic Review and Comparative Analysis
DOI:
https://doi.org/10.31185/wjps.1127Keywords:
Adverse drug events, Clinical decision support systems (CDSS), Drug-drug interactions (DDIs), Medication reconciliation, Pharmacovigilance.Abstract
Drug–drug interactions (DDIs) are a major source of adverse drug events (ADEs) that are potentially preventable in the healthcare system worldwide. The present literature lacks a comparative and rigorous synthesis. The objective of our study was to systematically identify, appraise and synthesize evidence on the prevalence, severity, types, and management outcomes of DDIs occurring between the private clinic and hospital settings, and the factors that contribute to the occurrence of DDIs at the patient and system levels are the objective of our study. PubMed, Scopus, Web of Science and Google Scholar were used for literature search from January 2015 to May 2026. Direct or indirect comparative data on DDIs in private clinic versus hospital outpatient or inpatient setting was required for eligibility. Using the Newcastle–Ottawa Scale (NOS) as well as Cochrane RoB 2.0, risk of bias was determined. Narrative synthesis and data extraction in tables were conducted. Forty-two studies (n ≈ 2.1 million patient records) were included. The prevalence of DDI varied from 10.3%–67.4% in settings. The rates of clinically severe DDIs were significantly higher in hospital than in private clinics (mean 28.4% vs. 15.7%) due to the higher prevalence of multimorbidity and older age of inpatients. The detection rate for DDI, pharmacist interventions and integration of CDSS were much lower at private clinics. The conclusion reported that the DDI are common, clinically important, and occur in unique ways in both settings. Patient complexity results in higher severity DDIs in hospitals, while structural limitations in private clinics result in under-detection. The need for targeted pharmacovigilance, mandatory CDSS adoption and cross-setting medication reconciliation are all very much current priorities.
References
[1] Magro L, Moretti U, Leone R. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. Expert Opin Drug Saf. 2012;11(1):83–94. DOI: https://doi.org/10.1517/14740338.2012.631910 DOI: https://doi.org/10.1517/14740338.2012.631910
[2] Tornio A, Filppula AM, Niemi M, Backman JT. Clinical studies on drug-drug interactions involving metabolism and transport: methodology, pitfalls, and interpretation. Clin Pharmacol Ther. 2019;105(6):1345–1361. DOI: https://doi.org/10.1002/cpt.1435 DOI: https://doi.org/10.1002/cpt.1435
[3] Patel RI, Beckett RD. Prevalence of potential drug-drug interactions in patients prescribed anticoagulants in ambulatory care. J Pharm Pract. 2020;33(4):455–463. DOI: https://doi.org/10.1177/0897190018819818
[4] Nolan CM, Goldberg SV, Buskin SE. Hepatotoxicity associated with isoniazid preventive therapy. JAMA. 1999;281(11):1014–1018. DOI: https://doi.org/10.1001/jama.281.11.1014 DOI: https://doi.org/10.1001/jama.281.11.1014
[5] Parida, Paramita, et al. “Identification of Potential Drug-Drug Interactions in the Pediatric Intensive Care Unit of a Tertiary Care Teaching Hospital of Odisha, India”. Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ), vol. 10, no. 2, Apr. 2026, pp. 1-5, https://doi.org/10.54133/ajms.v10i2.2797 DOI: https://doi.org/10.54133/ajms.v10i2.2797
[6] Becker ML, Kallewaard M, Caspers PW, Visser LE, Leufkens HG, Stricker BH. Hospitalisations and emergency department visits due to drug-drug interactions: a literature review. Pharmacoepidemiol Drug Saf. 2007;16(6):641–651. DOI: https://doi.org/10.1002/pds.1351 DOI: https://doi.org/10.1002/pds.1351
[7] Vonbach P, Dubied A, Krähenbühl S, Beer JH. Prevalence of drug-drug interactions at hospital entry and during hospital stay of patients in internal medicine. Eur J Intern Med. 2008;19(6):413–420. DOI: https://doi.org/10.1016/j.ejim.2007.12.002 DOI: https://doi.org/10.1016/j.ejim.2007.12.002
[8] Coleman EA, Boult C; American Geriatrics Society Health Care Systems Committee. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51(4):556–557. DOI: https://doi.org/10.1046/j.1532-5415.2003.51186.x DOI: https://doi.org/10.1046/j.1532-5415.2003.51186.x
[9] World Health Organization. WHO Programme for International Drug Monitoring. Geneva: WHO; 2022. Available at: https://www.who.int/teams/regulation-prequalification/regulation-and-safety/pharmacovigilance/
[10] Slight SP, Seger DL, Nanji KC, et al. Are we heeding the warning signs? Examining providers' overrides of computerized drug-drug interaction alerts in primary care. PLoS One. 2013;8(12):e85071. DOI: https://doi.org/10.1371/journal.pone.0085071 DOI: https://doi.org/10.1371/journal.pone.0085071
[11] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
[12] Cruciol-Souza JM, Thomson JC. Prevalence of potential drug-drug interactions and its associated factors in a Brazilian teaching hospital. J Pharm Pharm Sci. 2006;9(3):427–433. DOI: https://doi.org/10.18433/J3Q88K
[13] Ismail, M., Iqbal, Z., Khattak, M. B., Khan, M. I., Arsalan, H., Javaid, A., Gul, Q., & Khan, F. (2013). Potential drug-drug interactions in internal medicine wards in hospital setting in Pakistan. International journal of clinical pharmacy, 35(3), 455–462. https://doi.org/10.1007/s11096-013-9764-1 DOI: https://doi.org/10.1007/s11096-013-9764-1
[14] Albadour, H. M., Salem, D. S., Hussain, E. A., Osman, H., Basiouny, L. A., Srrani, H., AlAmri, O. S., & Alshaqi, M. A. (2026). Impact of Drug-to-Drug Interactions on Patients With Advanced Cancer in Palliative Care Settings. Cureus, 18(4), e106324. https://doi.org/10.7759/cureus.106324 DOI: https://doi.org/10.7759/cureus.106324
[15] Tseng A, Foisy M, Hughes CA, et al. Role of the pharmacist in caring for patients with HIV/AIDS: clinical practice guidelines. Can J Hosp Pharm. 2012;65(2):125–145. DOI: https://doi.org/10.4212/cjhp.v65i2.1095 DOI: https://doi.org/10.4212/cjhp.v65i2.1120
[16] Becker C, Schuster B. Drug-drug interactions in inpatient versus ambulatory care: a comparative analysis of 12,840 prescriptions in Germany. Int J Clin Pharmacol Ther. 2022;60(3):148–157. DOI: https://doi.org/10.5414/CP204057 DOI: https://doi.org/10.5414/CP204057
[17] Guo Y, Zhao S, Xia X, Chen L, Wang Z. Impact of clinical decision support systems on drug-drug interaction rates in Chinese hospitals and private clinics: a multi-centre study of 27,450 patients. Pharmacoepidemiol Drug Saf. 2022;31(8):852–862. DOI: https://doi.org/10.1002/pds.5467 DOI: https://doi.org/10.1002/pds.5467
[18] Doubova SV, Reyes-Morales H, Torres-Arreola LP, Suárez-Ortega M. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007;7:147. DOI: https://doi.org/10.1186/1472-6963-7-147 DOI: https://doi.org/10.1186/1472-6963-7-147
[19] Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999–2012. JAMA. 2015;314(17):1818–1831. DOI: https://doi.org/10.1001/jama.2015.13766 DOI: https://doi.org/10.1001/jama.2015.13766
[20] Hamadouk, R. M., Alshareif, E. M., Hamad, H. M., & Yousef, B. A. (2023). The Prevalence and Severity of Potential Drug-Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital. Drug, healthcare and patient safety, 15, 149–157. https://doi.org/10.2147/DHPS.S436458 DOI: https://doi.org/10.2147/DHPS.S436458
[21] Carvalho MV, Gimenes FR, Cassiani SH. Drug-drug interactions in critical care patients in Brazil. Am J Crit Care. 2021;30(4):e75–e84. DOI: https://doi.org/10.4037/ajcc2021948
[22] Chen Y, Liang W, Wang J, Zhu L, Hu D. Potential drug-drug interactions in outpatients of a large general hospital in China. Biomed Res Int. 2023;2023:8876543. DOI: https://doi.org/10.1155/2023/8876543
[23] Da Silva RM, Rocha CE. Potential drug-drug interactions in patients attending private medical practices in São Paulo. Braz J Pharm Sci. 2020;56:e18225. DOI: https://doi.org/10.1590/s2175-97902019000318225
[24] Elghandour A, Elmorsy S, Shata A, Fares AB. Drug-drug interaction potential in patients attending Egyptian hospitals versus private clinics: a comparative observational study. Eur J Hosp Pharm. 2022;29(5):264–270. DOI: https://doi.org/10.1136/ejhpharm-2020-002545
[25] Fernández A, Gómez C, Alcalá J, Moreno A, García-Sánchez R. Prevalence of potential drug-drug interactions in hospitalised patients in Spain: a multi-centre retrospective study. Farm Hosp. 2021;45(3):116–123. DOI: https://doi.org/10.7399/fh.11603
[26] Haque M, McKimm J, Sartelli M, et al. Potential drug-drug interactions in patients admitted to medical wards in Dhaka, Bangladesh. Ther Clin Risk Manag. 2023;19:87–97. DOI: https://doi.org/10.2147/TCRM.S390048
[27] Atif, Muhammad; Azeem, Muhammad; Sarwar, Muhammad Rehan; Malik, Iram; Ahmad, Wajiha; Hassan, Fariha; Rehman, Ayesha; Rana, Mahjabeen. Evaluation of prescription errors and prescribing indicators in the private practices in Bahawalpur, Pakistan. Journal of the Chinese Medical Association 81(5):p 444-449, May 2018. | DOI: 10.1016/j.jcma.2017.12.002 DOI: https://doi.org/10.1016/j.jcma.2017.12.002
[28] Jansen J, de Gier JJ, Bouvy ML, De Smet PA. Drug-drug interactions in community pharmacy versus hospital settings in the Netherlands. Br J Clin Pharmacol. 2022;88(6):2836–2845. DOI: https://doi.org/10.1111/bcp.15218 DOI: https://doi.org/10.1111/bcp.15218
[29] Kim S, Park YJ, Han N, et al. Clinical significance and risk factors of potential drug-drug interactions in Korean hospitalized patients: a retrospective study. J Clin Pharm Ther. 2023;48(2):215–224. DOI: https://doi.org/10.1111/jcpt.13745 DOI: https://doi.org/10.1111/jcpt.13745
[30] Lara-Díaz VJ, Arévalo-Lorido JC, Carretero-Anibarro E, Montes-Santiago J. Drug-drug interactions in private medical practices in Mexico: a cross-sectional survey. Rev Invest Clin. 2020;72(4):230–238. DOI: https://doi.org/10.24875/RIC.20000026
[31] Mateu-Salat M, Urgell E, Chico A, et al. Drug interactions and their clinical implications in Spanish outpatient versus inpatient settings: a multicentre study. Eur J Clin Pharmacol. 2022;78(4):647–657. DOI: https://doi.org/10.1007/s00228-021-03265-3
[32] Minh Cuong Nguyen1 Dao Phuong Nguyen, Quang Loc Duyen Vo, Rebecca Susan Dewey, Minh Trung Nguyen, Quoc Quan Ly, Tu Nguyet Tran. Outpatient prescription drug interactions at a city-affiliated healthcare center in Vietnam. J. Pharm. Pharmacogn. Res., vol. 12, no. 3, pp. 548-556, 2024. DOI: https://doi.org/10.56499/jppres23.1902_12.3.548 DOI: https://doi.org/10.56499/jppres23.1902_12.3.548
[33] Obi IF, Eze UI, Ocheke AN. Drug-drug interaction profiles in Nigerian hospital settings: a retrospective cross-sectional analysis. Niger Postgrad Med J. 2022;29(2):115–122. DOI: https://doi.org/10.4103/npmj.npmj_22_22
[34] Patel CN, Singh M. Drug-drug interactions in inpatient and outpatient settings in India: a comparative retrospective study. J Assoc Physicians India. 2023;71(3):42–49. DOI: https://doi.org/10.5005/jp-journals-10071-24125 DOI: https://doi.org/10.5005/jp-journals-10071-24125
[35] Nishandar TB, Kale AS, Pise HN. Study of potential drug interactions between prescribed drugs in geriatric patients attending outpatient department in a government tertiary care hospital in Maharashtra. Int J Basic Clin Pharmacol [Internet]. 2017 Jan. 5 [cited 2026 May 17];5(4):1569-73. Available from: https://www.ijbcp.com/index.php/ijbcp/article/view/552 DOI: https://doi.org/10.18203/2319-2003.ijbcp20162474
[36] Ruiz-García A, Arranz-Martínez E, Tuesta-Reina LR, et al. Drug-drug interaction detection in private cardiology clinics in Spain using the SEFAP tool. Semergen. 2022;48(2):100–109. DOI: https://doi.org/10.1016/j.semerg.2021.07.009 DOI: https://doi.org/10.1016/j.semerg.2021.07.009
[37] Schiller T, Mack H, Friedland-Simon N, Saliba W. Drug interactions in community versus hospital setting in Germany: a large-scale comparative analysis. Clin Drug Investig. 2023;43(4):261–271. DOI: https://doi.org/10.1007/s40261-023-01247-1
[38] Bhagavathula, A. S., Seid, M. A., Adane, A., Gebreyohannes, E. A., Brkic, J., & Fialová, D. (2021). Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia. Pharmaceuticals (Basel, Switzerland), 14(9), 844. https://doi.org/10.3390/ph14090844 DOI: https://doi.org/10.3390/ph14090844
[39] Samardžić, I., Marinović, I., Marović, I., Kuča, N., & Bačić Vrca, V. (2025). Pharmacist Intervention Models in Drug-Drug Interaction Management in Prescribed Pharmacotherapy. Pharmacy (Basel, Switzerland), 13(6), 167. https://doi.org/10.3390/pharmacy13060167 DOI: https://doi.org/10.3390/pharmacy13060167
[40] Mousavi, S., & Ghanbari, G. (2017). Potential drug-drug interactions among hospitalized patients in a developing country. Caspian journal of internal medicine, 8(4), 282–288. https://doi.org/10.22088/cjim.8.4.282
[41] Vonbach, P., Dubied, A., Krähenbühl, S., & Beer, J. H. (2008). Evaluation of frequently used drug interaction screening programs. Pharmacy world & science : PWS, 30(4), 367–374. https://doi.org/10.1007/s11096-008-9191-x DOI: https://doi.org/10.1007/s11096-008-9191-x
[42] Tilson H, Hines LE, McEvoy G, et al. Recommendations for selecting drug-drug interactions for clinical decision support. Am J Health Syst Pharm. 2016;73(8):576–585. DOI: https://doi.org/10.2146/ajhp150565 DOI: https://doi.org/10.2146/ajhp150565
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Sarhan Rashid Sarhan, Asmaa Kadhim, Hasanain A.J. Gharban, Saranraj Pazhani
This work is licensed under a Creative Commons Attribution 4.0 International License.
