Actual Drug-related Problems Research Articles

Impact of a clinical decision support system on identifying drug-related problems and making recommendations to providers during community pharmacist-led medication reviews in Ontario, Canada: A pilot study.

To evaluate the impact of a clinical decision support system (CDSS) to identify drug-related problems (DRPs) during community pharmacist medication reviews. Pilot 3-phase (group), open-label study. Two community pharmacies in Sarnia, Ontario, with pharmacists providing medication reviews to patients. Five pharmacists participated in three phases (groups). During Phase 1, pharmacists conducted medication reviews in 25 adult patients using the usual approaches. In Phase 2, pharmacists were trained to use a CDSS to identify DRPs, and then conducted medication reviews using the tool in a different group of 25 adult patients. In Phase 3, pharmacists conducted medication reviews without the aid of the CDSS in 25 additional adult patients. The primary outcome was recommendation to the primary care physician to alter pharmacotherapy based on medication review, assessed using mean number and frequency (yes/no) of recommendations by patient. Secondary outcomes included number of potential DRPs, actual DRPs, medication review duration time, pharmacist's perceptions of the CDSS and patient satisfaction with medication review. The mean number of recommendations to primary care physicians to alter pharmacotherapy per patient in Phases 1, 2 and 3 did not differ: 1.0 (SD = I.2) versus 1.5 (1.0) versus 1.5 (1.0), respectively; p = 0.223. The percentage of patients with a pharmacy recommendation sent to physicians across the phases, however, differed: 52% versus 80% versus 88%, respectively; p = 0.010, with more in Phases 2 and 3 compared to 1. There were more potential DRPs in group 2 compared to other groups. There were no differences in actual DRPs and medication review time. Pharmacists had positive attitudes about the CDSS. Patients were generally satisfied with their medication review. This small pilot study provides some preliminary evidence for performance and feasibility of a CDSS to identify DRPs that pharmacists will act on. Future research is recommended to validate these findings in a larger sample.

Prospective observational study of medication reviews in internal medicine wards: evaluation of drug-related problems

BackgroundThe Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from...

Pengaruh Intervensi Apoteker terhadap Tingkat Bahaya Drug-Related Problems pada Pasien Geriatrik Rawat Inap

Geriatric patients are at high risk of Drug-Related Problems (DRPs) associated with multimorbidity, physiologic changes, and pharmacologic alterations, that caused by the aging process. The pharmacist plays an important role in optimizing the effectiveness and safety of the patient’s drug therapies. This study aims to know the effect of pharmacist intervention in reducing the harmful levels of DRPs and to know the factors associated with the reduction of DRPs harm level in hospitalized geriatric patients. This research uses quasi-experimental study with a one-group pretest and posttest design. This research was conducted in Panti Rapih Hospital between March-April 2021, with patients’ inclusion criteria of ≥ 60 years old, with internal diseases cases, and identified DRPs in the therapy. The exclusion patient criteria are hospitalized in the intensive unit and Covid-19 ward. A pharmacist reviewed patient drug therapy, identified and solved DRPs. The harm level of DRPs was compared before and after pharmacist interventions. The harm level of DRPs was determined through professional adjustment according to The Harm Associated with Medication Error Classification tools, then analyzed using Wilcoxon test with a level of confidence 95%. Factors of age, the number of drugs received by the patient, comorbidities, and acceptance of the intervention were investigated for their effect on reducing the harm level of DRPs using a multivariate logistic regression test. A total of the research subject were 28 inpatients, with 47 DRPs identified. The most frequent DRPs were adverse drug reactions (27,66%). Among all interventions, 77,36% of them were accepted with full implementation. The pharmacist intervention resulted in a significant reduction in the harm level of both potential and actual DRPs (p < 0,05). A factor of the number of drugs received by patients and acceptance of pharmacist intervention was associated with the reduction of the harm level of DRPs (p < 0,05). This study shows that multidisciplinary collaboration is needed in the care of geriatric patients.

Acceptance and importance of clinical pharmacists’ LIMM-based recommendations

The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists. The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher. This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.

Improving pharmaceutical care in oncology by pharmacoinformatics: the evolving role of informatics and the internet for drug therapy

Health-care has rapidly evolved with the informatics revolution. The rapid growth of the world-wide web as a tool for global connectivity has affected the way in which health-related information is distributed and accessed over the internet. Many informatics and internet applications are now available for use by both oncology health-care professionals and patients with cancer, with many people using the internet to search for drug-related and other health-related information. The practice of pharmaceutical care aims to ensure optimum medication-related therapeutic outcomes in patients, and involves identifying, solving, and preventing potential or actual drug-related problems (DRPs) with regards to a patient's drug therapy. Pharmacoinformatics involves the use of informatics, the internet, and interactive technologies to solve DRPs, with a focus on providing optimum pharmaceutical care and improved patient safety. This paper highlights the different pharmacoinformatics channels that have been used in the provision of pharmaceutical care, which are relevant to both oncology health-care professionals and patients with cancer. We will discuss several issues that have arisen as a result of cybermedicine, which can potentially affect the quality of pharmaceutical care in patients with cancer, and also provide insights into how pharmacoinformatics can potentially affect the future of healthcare. The opportunity of integrating pharmacoinformatics in the practice of clinical oncology as an aid to solve DRPs is indeed appealing. Oncology practitioners should not only focus on the acquistion of new treatment strategies, but also continue to embrace and harness new information and communication technologies, so as to increase their efficiency and improve on the pharmaceutical care of patients with cancer.

Pharmaceutical Care Research and Education Project: Pharmacists' Interventions

To describe the processes of care used by community pharmacists participating in the Pharmaceutical Care Research and Education Project (PREP) in terms of drug-related problems (DRPs), pharmacists' recommendations, and status of DRPs at follow-up, and to determine characteristics associated with DRPs. Descriptive analysis of the treatment group from a larger randomized, controlled cluster design. Five independent community pharmacies in Alberta. One hundred fifty-nine patients who were covered under Alberta Health and Wellness's senior drug benefit plan (i.e., 65 years or older), were taking three or more medications concurrently according to pharmacy records, were able to complete telephone interviews as determined by pharmacists, maintained residence in Alberta for 12 of the 15 study months, agreed to receive their prescription medications only from the study pharmacy during the study period, and provided informed consent. Frequency of DRPs, recommendations, status of DRPs, and analysis of clinical results as determined during pharmacists' follow-up care. In telephone surveys, patients reported taking 4.7 prescription medications per day, but pharmacists documented 8.7 prescription medications per day in their records. Pharmacists documented 559 DRPs, a mean (+/- SD) of 3.9+/-3.2 problems per patient. Approximately 39% of problems were actual DRPs, while 60% were potential DRPs. Medical conditions associated most frequently with a DRP involved the respiratory, cardiovascular, and musculoskeletal systems. The most common DRP categories were "patient requires drug therapy" or "patient requires influenza or pneumococcal vaccination." Pharmacists wrote 551 initial clinical notes using the subjective, objective, assessment, plan (SOAP) format, and they recorded 346 follow-up interventions, also using SOAP notes. Counseling, preventive consultations, and clinical monitoring represented 40% of their recommendations. In 80% of situations, the pharmacist made the recommendation directly to the patient. On follow-up, 40% of the 559 DRPs identified were resolved, controlled, or improved. Patients accepted 76% of pharmacists' recommendations, and physicians accepted 72% of pharmacists' suggested resolutions of DRPs. Pharmacists were more likely to follow up about actual DRPs, as compared with potential ones; overall, they followed up on 62% of identified DRPs. Pharmacists identified more DRPs for study patients than previous community-based, observational studies have reported. Undertreatment appears to be a prevalent DRP. Community pharmacists' recommendations to prevent and resolve DRPs were made primarily to patients and were well accepted. More follow-up was needed for all DRPs. When follow-up occurred, the DRP results generally showed improvement.

Clinical and economic effects of pharmacy services in geriatric ambulatory clinic.

Pharmacy services were introduced in an established multidisciplinary geriatric ambulatory clinic. The pharmacist collaborated with primary care providers to optimize patients' drug regimens. Over 8 months there were 250 patient visits to the clinic. Traditional medical care was provided at 144 (57.6%) of these visits and traditional medical care plus pharmacist evaluation was provided at 106 (42.4%). The pharmacist identified 220 potential and actual drug-related problems. Acceptance of pharmacist-recommended changes in drug therapy was 98.6%. A mean reduction of 3.4 agents/patient was achieved in the intervention group (p<0.0001). Clinical outcomes of changes in drug therapy were neutral or positive in 99.5% of cases. Pharmacy services resulted in net savings of $7,788 annually.