Abstract
During the dispensing process of medical orders (MOs), community pharmacists (CPs) can manage drug-related problems (DRPs) by performing pharmacist interventions (PIs). There is little evidence that the PI rate is higher with MOs from hospitals (MOHs) than ambulatory (MOAs) settings, and their impact on the patient and community pharmacy is unknown. The primary objective of this study was to compare the MOH and MOA PI rates. The secondary objective was to describe PIs and their clinical and organizational impacts on patient and community pharmacy workflow. A total of 120 CPs participated in a prospective study. Each CP included 10 MOH and 10 MOA between January and June 2020. DRP and PI description and clinical and organizational impacts between MOH and MOA were assessed and compared. We analyzed 2325 MOs. PIs were significantly more frequent in MOH than in MOA (9.7% versus 4.7%; p < 0.001). The most reported PI was the difficulty of contacting hospital prescribers (n = 45; 52.2%). MOHs were associated with a longer dispensing process time and a greater impact on patient pathway and community pharmacy workflow than MOAs. Lack of communication between hospital and primary care settings partly explains the results. Implementation of clinical pharmacy activities at patient discharge could alleviate these impacts.
Highlights
A large part of the community pharmacist’s working time is devoted to the dispensation of medical orders (MOs) for all types of patients, mainly coming from ambulatory or hospital settings [1]
There was no difference in drug-related problems (DRPs) and pharmacist interventions (PIs) subtype frequencies depending on the MO setting
This study reported the potential clinical impact of PIs on patient care pathway and on Community pharmacists (CPs) workflow related to MOs from the hospital or ambulatory settings separately
Summary
A large part of the community pharmacist’s working time is devoted to the dispensation of medical orders (MOs) for all types of patients, mainly coming from ambulatory or hospital settings [1]. CPs may detect drug-related problems (DRPs) [3] that they must manage and track by performing pharmacist interventions (PIs). In France, the French Society of Clinical Pharmacy (SFPC) developed and validated a reporting tool for the uniform detection and classification of pharmacist interventions in our hospitals [4]. Additional DRPs can be detected on hospital Mos for several reasons such as the time of discharge, infrequently used or very expensive drugs (most of them unavailable immediately), and difficulties in calling prescribers [6,7,8]. Each DRP can result in clinical impacts for the patient and in organizational impacts for community pharmacy teams (e.g., additional workload and difficulties related to professional task shifting) and patients (e.g., additional visits to the pharmacy)
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