Methods: This study used an interrupted time series de- sign. In a health maintenance organization with an elec- tronic medical record, we evaluated the effectiveness of electronic medical record alerts and group academic de- tailing to reduce the coprescribing of warfarin and in- teracting medications. Participants were 239 primary care providers at 15 primary care clinics and 9910 patients taking warfarin. All 15 clinics received electronic medi- cal record alerts for the coprescription of warfarin and 5 interacting medications: acetaminophen, nonsteroi- dal anti-inflammatory medications, fluconazole, metro- nidazole, and sulfamethoxazole. Seven clinics were ran- domly assigned to receive group academic detailing. The primary outcome, the interacting prescription rate (ie, the number of coprescriptions of warfarin-interacting medications per 10 000 warfarin users per month), was analyzed with segmented regression models, control- ling for preintervention trends. Results: At baseline, nearly a third of patients had an interacting prescription. Coinciding with the alerts, there was an immediate and continued reduction in the war- farin-interacting medication prescription rate (from 3294.0 to 2804.2), resulting in a 14.9% relative reduc- tion (95% confidence interval, �19.5 to �10.2) at 12 months. Group academic detailing did not enhance alert effectiveness. Conclusions: This study, using a strong and quasi- experimental design in ambulatory care, found that medi- cation interaction alerts modestly reduced the frequency of coprescribing of interacting medications. Additional ef- forts will be required to further reduce rates of inappro- priate prescribing of warfarin with interacting drugs. Arch Intern Med. 2006;166:1009-1015
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