Place du pharmacien clinicien dans la prise en charge thérapeutique du patient hypertendu

Abstract

PurposeTo synthesize pharmacists’ interventions made in the department of internal medicine and hypertension of university hospital of Toulouse and assess the impact on medication orders. MethodsThis is a single-center, prospective study using pharmacists’ interventions recorded between September 2013 and March 2014 on the Act-IP© website of the French Society of Clinical Pharmacy. The clinical pharmacist is present everyday in the unit to establish the medication reconciliation of new patients (the process of comparing a patient's medication orders to all of the medications that the patient has been taking), and analysis of medication orders. When a risk of iatrogenic drug is identified, a therapeutic change is proposed to the prescriber. ResultsA total of 2491 medication orders were analyzed for 7 months, leading to 39 pharmacists’ interventions (1.6 pharmacists’ interventions per 100 medication orders). The most commonly identified drug-related problems were improper administration (33%, n=13), not prescribed drug (21%, n=8), non-conformity to guidelines (18%, n=7), supratherapeutic dose (15%, n=6), and 13% (n=5) targeted prescribed treatment not administered, underdosing, incorrect administration or drug interaction. The most relevant molecules were atorvastatin (10%), bromazepam (8%) and levothyroxine (8%) and only 2 interventions targeted antihypertensive drugs. The rate of physicians’ acceptance was 92%. ConclusionPharmacists’ interventions mainly concern the co-prescriptions of antihypertensive drugs and very few antihypertensive drugs. The clinical pharmacist contributes to preventing iatrogenic in patients with hypertension with a very good acceptance by the clinician.