Drug-related Problems Classification Research Articles

Evaluation of a Clinical Pharmacist Intervention on Clinical and Drug-Related Problems Among Coronary Heart Disease Inpatients: A pre-experimental prospective study at a general hospital in Indonesia.

This study aimed to evaluate the role of a clinical pharmacist intervention in decreasing subsequent clinical and drug-related problems (DRPs) among coronary heart disease (CHD) inpatients with at least one previous DRP. This pre-experimental study with a pre-post design was carried out from January to April 2017 among inpatients with at least one previous DRP at a general hospital in Tangerang District, Banten, Indonesia. Clinical and DRPs were documented prospectively by a clinical pharmacist, with DRPs classified using Version 6.2 of the DRP classification scheme of the Pharmaceutical Care Network Europe Foundation. The intervention consisted of a discussion of identified DRPs with physicians, patients, pharmaceutical logistics clerks, nurses and nutritionists. Following this, any subsequent clinical and DRPs were re-identified and further interventions were conducted as necessary. A total of 75 inpatients were included in the study. Pre-intervention, there were 443 DRPs and 202 clinical problems. The most frequent DRPs were adverse drug reactions (52.6%), followed by drug effects (41.8%). Most DRPs were of moderate severity and would have resulted in moderate consequences had the pharmacist not intervened. The interventions resulted in a significant reduction in the number of DRPs, type of DRPs and number of clinical problems (P <0.05 each). Patients with complications were 26.047 times more likely to have no reduction or an increased number of clinical problems compared to patients without complications (P <0.05). Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.

Validating a Drug-Related Problems Classification System in Outpatient Setting in Iran.

Objective:Medication Therapy Management service (MTMs) has been introduced to improve cooperation among pharmacists and other healthcare professionals in the management of chronic diseases, drug therapy, and patients on polypharmacy. One part of MTMs is detection and resolution of possible drug-related problems (DRPs). Nowadays, numerous DRPs classification systems are available, but due to some defects none of them are currently accepted and implemented universally. The purpose of this study is to design and validate a comprehensive system for classification and documentation of possible DRPs for the Iranian patients.Methods:In this methodological study, four classification systems were studied, and their differences were reviewed, compared. Ultimately, a comprehensive documentation system was developed and tested for validity using experts' opinions.Findings:A comprehensive list of 53 DRPs under eight categories was developed and examined for validity. After collecting the data and validity assessment, questions with content validity ratio of <0.4 and content validity index of <70% were excluded and modified. Finally, with the exclusion and modification of eight DRPs, a modified DRPs list was created.Conclusion:According to the universality and validity assessment and based on consensus of 20 experts, this DRPs list can be used to regulate the standard operation procedure of outpatient clinics in Iran, and could act toward standardization of this service.

PHARMACIST INVOLVEMENT TO DECREASE DRUG-RELATED PROBLEMS AMONG GERIATRIC PATIENTS IN INDONESIAN PRIMARY HEALTH CENTERS

Objective: The studies have demonstrated that older people often suffer from multiple diseases and are thus prescribed many different drugs. Therefore, drug-related problems (DRPs) are common in the elderly. The main objectives of this study were to reduce the number of DRPs in the elderly through pharmacist involvement and to analyze differences after pharmacist recommendations.Methods: In a quasi-experimental study, 12 primary health centers were selected and randomly divided into two groups (six in each group). In the first group, the physicians received pharmacist recommendations verbally through discussions, and in the second group, the physicians received recommendations through letters. DRPs were analyzed from all older inpatients’ medical records 1 month before and 1 month after the pharmacist recommendations. The main outcome being measured was the incidence of DRPs, classified into problems, and causes according to the Indonesian translated version of Pharmaceutical Care Network Europe, Version 6.2 (PCNE V 6.2). The problems were identified based on journal articles and other relevant literature.Results: A total of 205 patients were analyzed before pharmacist intervention (Group 1: 121; Group 2: 84) and 202 patients after the intervention (Group 1: 108; Group 2: 94). The most common problem in these elderly patients was that they suffered from toxic effects. The most common cause was inappropriate drug selection. The number of DRPs and causes were decreased significantly through the discussions (Wilcoxon signed-rank test, problems p=0.027, causes p=0.028). DRPs were also significantly decreased through the recommendation letters (paired t-test, number of problems p=0.003, and causes p=0.004). Discussion with physicians seemed more effective and decreased more problems (p=0.001) and causes (p=0.002). Through discussions, the decrease in a number of problems was 20.83±8.931, and the decrease in the number of causes was 25.33±11.431 versus the recommendation letter, at 4.17±1.941 and 5.17±2.483, respectively.Conclusion: Pharmacist involvement decreased DRPs among older inpatients. Discussing DRPs with the physicians treating the patients is more effective than giving recommendations in writing only. The PCNE V 6.2 DRP classification system is useful for documenting DRPs among the elderly as it can help pharmacists develop plans to reduce DRPs.

Assessment of a Clinical Pharmacy Activity in a Pediatric Inpatient Department in Cote D'ivoire.

Background:Clinical pharmacy activities in a pediatric inpatient department help to improve the management of patients clinically and economically.Objective:To assess the relevance of pharmaceutical interventions (PIs) in a pediatric inpatient department in Abidjan (Cote d’Ivoire).Materials and Methods:We carried out a cross-sectional, descriptive study from February to September 2014. The information collected was classified according to the classification of drug-related problems (DRPs) and PIs of the French Society of Clinical Pharmacy. The score assigned to each PI varied from PI0 (without direct clinical impact) to PI3 (vital clinical impact) as the importance of the potential clinical impact of the DRP was correlated to the severity of clinical consequences avoided by the PI. The relevance of PIs was assessed by their rate of acceptance by physicians and by the analysis of their clinical impact.Results:A total of 116 PIs were performed with 31% performed during medical rounds, 68.1% during patients’ records analysis, and 0.1% on patient's admission. The main DRPs were related to noncompliance with recommendations (24.1%), overdose (21.1%), and underdosing (13.8%). The most important PIs were dose adjustment (31.8%), accuracy of drugs administration modalities (29.3%), and proposals of therapeutic choice (27.6%). The acceptance rate of PIs was highly significant (94.8%). The majority of PIs (67.3%) was assessed as having a significant clinical impact (PI1) and 16.4% of PIs as very significant clinical impact (PI2). A single PI (0.9%) was found with vital clinical impact.Conclusion:PIs performed were relevant and contributed to the therapeutic optimization and the prevention of iatrogenic events in pediatric inpatients.

Pharmacist intervention in drug-related problems for patients with cardiovascular diseases in selected community pharmacies in Northern Cyprus

Purpose: To investigate the role of the community pharmacist in identifying, preventing and resolving drug related problems (DRPs) encountered by patients, with particular emphasis on cardiovascular drugs in community pharmacies in Northern Cyprus, Turkey. Methods: A prospective observational study for the assessment of DRPs and pharmacist interventions in cardiovascular diseases patients was conducted over a period of four months at four community pharmacies in North Cyprus. Interventions were then evaluated and classified using the Pharmaceutical Care Network Europe PCNE DRP classification tool V6.2. Results: It was determined that 63 % of patients requiring intervention had problems related to drug use linked to existing diseases. The most common cause of DRPs was adverse drug reactions (ADR, 54 %), while the most common reason for DRPs in this group, ‘Others’ (54 %), was significantly (p < 0.0001); ‘Others’ included compliance problems and unclassified complaints. All patients were counseled. Sixty three percent of the encountered DRPs were completely resolved after intervention; the outcome of the intervention was unknown in 36 % of the patients, but the problem could not be solved in only 1 %. Conclusion: Adverse drug reactions are the most common DRPs in patients with cardiovascular disease. Pharmacist intervention is effective in reducing the level of DRPs. Keywords: Drug related problems (DRPs), Adverse drug reactions (ADRs), Pharmaceutical Care Network Europe (PCNE), Community pharmacists, Intervention, Cardiovascular diseases

Pharmaceutical interventions in the management of tuberculosis in a pneumophtisiology department, Ivory Coast.

ObjectivesThis study aims to analyze the profile and relevance of pharmaceutical interventions (PIs) in the management of tuberculosis (TB) at inpatient settings.Patients and methodsCross-sectional descriptive study conducted from March to December 2014 within the inpatient unit of pneumophtisiology department, Ivory Coast. Information collected was based on the classification of drug-related problems (DRPs) and PIs outlined by the French Society of Clinical Pharmacy. A score was assigned to each PI according to the importance of the potential clinical impact. This score was correlated with the severity of clinical consequences avoided by the intervention. The listing of interventions was made by pneumophtisiology specialists. The score assigned to each intervention ranged from 0 (without clinical impact) to 3 (vital clinical impact). The acceptance rate of interventions by physicians was evaluated.ResultsOf 130 patients, 28.5% received PIs. The main reasons for interventions were drug–drug interactions (26.4%), noncompliance with recommendations (24.5%), and adverse effects (24.5%). Antituberculosis drugs were involved in 40.3% of DRPs. Interventions were predominantly proposals for monitoring treatment effectiveness and safety parameters (52.7%) followed by proposals of therapeutic choice (28.1%). All interventions were accepted by the physicians. Most interventions (59.6%) were listed as interventions with significant clinical impact.ConclusionThe presence of a pharmacist at inpatient setting has contributed to the prevention and resolution of problems related to the pharmacotherapeutic management of TB. Pharmacists can position themselves as major players in the therapeutic management of TB inpatient in resource-limited setting.

Assessment of the relevance of pharmacist interventions in the management of malaria at a paediatric unit in Cote d'Ivoire

Objectives The involvement of pharmacists is very important in achieving the goals of therapeutic management of malaria. This study aimed to analyse the profile of pharmacist interventions (PIs) and to assess their relevance in cases of malaria in children. Methods We conducted a cross-sectional descriptive study in a general hospital in Cote d'Ivoire. The information collected was based on the classification of drug-related problems (DRPs) and PIs of the French Society of Clinical Pharmacy. The score assigned to each PI varied from PI0 to PI3 according to its clinical impact. The rating used was as follows: PI0 (PI without direct clinical impact); PI1 (PI with significant clinical impact); PI2 (PI with very significant clinical impact); and PI3 (PI with vital clinical impact). The relevance of PIs was evaluated by their acceptance rate by physicians and by their clinical impact. Key findings The study included 323 patients. The main DRPs detected were untreated indications (63%) and overdose (26%). The most important PIs concerned propositions of therapeutic choice (90%) (drug addition and treatment discontinuation). Antimalarial drugs were implicated in 14% of PIs. All PIs were accepted by the physicians. PIs were rated by physicians as PI0 (66%) and as PI1 (34%). Conclusion Pharmacist interventions for malaria in children were relevant with a high acceptance rate and an appreciable clinical impact.

Development and validation of the Slovenian drug-related problem classification system based on the PCNE classification V 6.2.

Background Classifying drug-related problems increases pharmacists' awareness of patients' drug-related needs and supports the development of counselling skills through increased awareness of the nature and frequency of drug-related problems. No standardised classification system was used in daily pharmacy practice in Slovenia. Objective To translate, upgrade and validate the Pharmaceutical Care Network Europe (PCNE) classification V 6.2 for use in Slovenian community pharmacies. Setting Expert panel meetings at the Faculty of Pharmacy and home-based classification validation. Methods The PCNE classification V 6.2 was translated to Slovenian language by forward-backward translation procedure. An expert panel consisting of nine practicing pharmacists upgraded the content of the translated version. Thirty-one community pharmacists validated this version with the PCNE set of 18 patient cases by coding problems, risk factors and interventions they believed were present in each case. The expert panel discussed the results and upgraded the classification accordingly. Afterwards, 33 community pharmacists validated the upgraded version with a set of 40 actual Slovenian pharmacy patient cases. Based on the results, the expert panel formed a final version of the classification. Main outcome measure Coding consistency between community pharmacists. Results The expert panel performed some major modifications to the PCNE classification V 6.2: the potential problem was added as a sub domain to problems domain; the term adverse drug event was used instead of adverse drug reaction; the causes domain was renamed to risk factors and its sub domains were organized into prescribing, dispensing and use of drugs; dispensing errors were specified; use of drugs was organized into intentional and unintentional use of drugs; the sub domains in the interventions domain were divided according to the communication and agreement with the prescriber. The average coding consistencies in the first validation study were 75% (±16%) for problems, 74% (±20%) for risk factors and 94% (±10%) for interventions. The average coding consistencies in the second validation study were 83% (±16%) for problems, 85% (±17%) for risk factors and 80% (±20%) for interventions. Conclusion A drug-related problem classification for use in Slovenian community pharmacies was developed based on The PCNE classification V 6.2. The validation studies demonstrated high coding consistencies.

Development of an aggregated system for classifying causes of drug-related problems.

More than 20 different types of classification systems for drug-related problems (DRPs) and their causes have been developed. Classification is necessary to describe and assess clinical, organizational, and economic impacts of DRPs through documentation of collected data. However, many researchers have judged classification systems incomplete when describing their data, and have modified them or developed their own. This variability between systems has made study comparisons difficult. To perform a category-by-category comparison of the content of selected DRP classification systems to construct an aggregated cause-of-DRP classification system containing the content of all systems. DRP classification systems were identified after a literature review, with 7 chosen based on their use in varied health care settings, geographical diversity, frequency of use, and method of development. These systems were critically analyzed, and the content of each category was compared and aggregated where appropriate. A hierarchy of categories was constructed to include all content from all systems. Any modifications that previous studies may have made to the 7 systems were also cross-referenced to ensure that no concepts were missing from the newly aggregated system. Clinical examples to optimize application, and instructions for when or when not to use categories, were developed. Interrater agreement for classification of the causes of DRPs from 10 medication reviews was performed between 3 clinical pharmacists and the authors' gold standard. We found variation in developmental methods, category descriptions, number and types of categories, and validation methods between the 7 selected systems, together with intermingling of categories identified as causes of DRPs with DRPs themselves. A hierarchical classification system was constructed consisting of 9 cause-of-DRP categories, 33 subcategories, and 58 sub-subcategories, for which interrater agreements were 82.5%, 74.6%, and 58.8%, respectively. An aggregated classification system was constructed through a unique and transparent developmental process that may provide the most comprehensive description of causes of DRPs to date. This may facilitate teaching of pharmaceutical care, comparisons of clinical practice, and measurement of the effectiveness of pharmaceutical care interventions.

Drug-related problems identified by pharmacists conducting medication use reviews at a primary health center in Qatar.

Medication use review (MUR) is increasingly being recognized globally as a routine strategy performed by pharmacists to optimize the therapeutic outcomes of long-term medications. MUR services are not commonly available in hospitals and primary health care (PHC) centers in Qatar and no previous studies have reported the nature and extent of such services where they exist. To describe the extent and types of drug-related problems (DRPs) generated from MUR interactions conducted at a PHC facility in Qatar and to determine the effect of patient characteristics on the number of DRPs. This was a cross-sectional, descriptive and exploratory study. Data were generated and documented prospectively via semi-private interviews conducted by intervention pharmacists (n = 6). DRPs identified were categorized according to the Pharmaceutical Care Network of Europe DRP classification system. In 56 medication reviews conducted, a total of 173 DRPs were identified with an average of 3.3 DRPs per patient. The most commonly encountered DRPs were non-adherence (31 %), need for education (23 %), and adverse drug reactions (21 %). Patients receiving six or more medications had significantly higher number of DRPs compared to those receiving three medications (p ≤ 0.05). Furthermore, elderly patients tended to have more DRPs compared to younger patients and there was a linear relationship between age and DRPs. This study shows that patients receiving polypharmacy and the elderly in Qatar are vulnerable to experiencing DRPs, many of which are potentially preventable through MURs.

Application of drug-related problem (DRP) classification systems: a review of the literature.

For over 20years, researchers wanting to record, discuss and compare drug-related problems (DRPs) have had the task of choosing between a multiplicity of classification systems offering a variable number of categories identified as causes of DRPs and DRPs. To characterise studies which have reported DRPs through the use of a DRP classification system to determine types of classification systems chosen, factors influencing their choice, and methodological issues that may have affected their application. A systematic search of MEDLINE, CINAHL, International Pharmaceutical Abstracts (Ovid), EMBASE and PubMed was performed. All English language studies reporting DRPs through the use of a classification system published between January 2000 and July 2013 were reviewed, with no limitation on the type of study. Of 2,774 articles screened, 268 met our inclusion criteria. We identified the use of 20 different types of DRP classification systems. Three quarters of studies modified an existing classification system or developed their own. Few studies stated reasons for choice of system. We identified issues such as variability in skills of data collectors, selective choice of patients and missing data, affecting application of classification systems and limiting quality, analysis and comparison of studies. There appeared to be no consensus on preference or structure of classification systems. Future studies should consider addressing or acknowledging the methodological issues identified. Through identification and discussion of these problems, recommendations for future studies and for practice have been made.

Pharmacists' performance of clinical interventions during adherence support medication reviews

In New Zealand, pharmacists are funded to provide adherence support to their patients via a service called "Medicines Use Review" (MUR). The service is based on the assumption that the medication regimen is clinically appropriate and therefore does not include a clinical review. However, whether or not pharmacists make clinical recommendations to patients during MUR is unclear. To identify the types of drug-related problems (DRPs) and interventions provided during MUR in order to understand whether clinical interventions occur. A single district health board that funds MUR services was identified. The MUR providers that conducted MURs during the period (from 2007 - December 2011) were invited to participate. All MUR consultation records were reviewed and the data extracted were categorized according to the DRP Classification Scheme v6.2 by Pharmaceutical Care Network Europe (PCNE). DRPs that did not fit into the criteria were documented separately. Consultation records for 353 individual patients were obtained from five MUR providers. Of these patients, 56.4% were female and the median age was 73years. A total of 886 DRPs were identified and resulted in a total of 844 interventions. During this period, 2718 medications were prescribed to these MUR patients. The most frequent DRPs identified were problems with "health literacy" and "non-adherence" to medications. However 18.1% (n=160) of the DRPs were perceived as a clinical review that went beyond the practice of MUR. The most common intervention was "patient counselling" (20%), "compliance packaging provided" (16%) and "recommendation to change medication" (11%). In this study, pharmacists perhaps based on ethical, legal and moral obligations provided clinical interventions that exceeded those expected and funded in a MUR. Since MUR detected a low number of clinical DRPs when compared to clinical medication review services conducted previously, a funding system that only supports MUR might not provide the important clinical support required by patients. Patients who receive only MUR may potentially be missing out on optimal care.

PHP67 Cost Analysis of Home-Based Medication Reviews in a Multi-Ethnic Asian Population: A Pilot Study

COST ANALYSIS OF HOME-BASED MEDICATION REVIEWS IN A MULTI-ETHNIC ASIAN POPULATION: A PILOT STUDY Gan HP1, Koh TW2, Tham TY2, Thumboo J3, Koh HL1, Chew WZ4, Wee HL1 1National University of Singapore, Singapore, Singapore, 2Frontier Healthcare Group, Singapore, Singapore, 3Singapore General Hospital, Outram, Singapore, 4Guardian Pharmacy, Singapore, Singapore OBJECTIVES: To evaluate the feasibility and cost of conducting home-based medication reviews (HBMR) among community-dwelling multi-ethnic Singaporeans and permanent residents. METHODS: In this cross-sectional study, Chinese, Malay and Indian aged 40 and over and on at least 5 medications were referred by their general practitioners (GPs) for HBMR. Patients completed a survey on sociodemographic and clinical information. Pharmacists’ time spent on HBMR and preparing visit reports were captured and assigned a cost based on pharmacists’ average hourly wages. Drug related problems (DRP) were evaluated using the Westerlund DRP classification system, reported to and followed up with the GPs. RESULTS: Of 14 participants referred, 9 consented (64.3%; 6 women; 6 Chinese, 2 Malays, 1 Indian; mean (SD, range) age: 69.3 (10.6, 52 – 86 years). Seven out of the 9 patient were under the care of at least two physicians. Dyslipidemia, hypertension and diabetes are the main condition affecting the participants (100%, 88.9%, 66.7%, respectively). A total of 12 DRP were detected: underuse of medication (n 7, of which 2 were due to non-compliance), overuse of medication (n 1), incorrect timing (n 2) and therapy failure (n 2). Pharmacists spent an average 3.5 hours per home visit. Total programme cost was $787.5 (9 visits x $25/hr x 3.5hr/ visit). Hence, cost per DRP detected was estimated at $65.63. One of the DRP detected was vertigo without treatment. Hence, programme cost may be potentially offset by the savings from avoiding an episode of hospitalization due to fall. CONCLUSIONS: DRP is prevalent and potentially preventable but were undetected in this primary care sample. Hence, there is a role for HBMR. We are currently conducting a longitudinal randomized controlled trial to evaluate the cost-effectiveness of providing and not providing HBMR by collecting direct and indirect costs, health services utilization and health-related quality of life outcomes at baseline and 6-months.

Pharmazeutische Betreuung einer viszeralchirurgischen Station

Medication errors and subsequent drug-related problems (DRPs) result from lack of sufficient information during the prescribing step. The objectives of this study were to evaluate the contribution of having a pharmacist participate in clinical routine on a surgical unit by studying DRPs, and the classification of DRPs in the Pharmaceutical Care Network Europe (PCNE) system. The pharmacotherapy of all patients of a visceral surgical ward was evaluated by a pharmacist in a prospective study design over a six-month period. The identified DRPs were classified using the PCNE system. In 29 131 prescription lines, 697 DRPs were registered. This corresponds to a mean intervention rate of 2.4 %. All DRPs were classified into the modified PCNE system with 910 causes and 1 148 interventions. The most frequent DRPs were "lack of home medication" (35.6 %), drug dosing problems (18.6 %), the inappropriate duplication of drugs of the same therapeutic group (6.7 %) and drug interactions (6.5 %). 78.6 % vs. 3.7 % of all registered DRPs were completely vs. near completely resolved by pharmacist. We consider the PCNE system with the four-level of classification to be a practical and easy-to-use tool in the daily hospital setting. Although we did not notice clinically relevant impairments of patient safety, a pharmacist may support the drug therapy and improve patient safety in clinics supporting the free choice of the drug therapy by the physician.

The incidence and nature of drug-related hospital admission: A 6-month observational study in a tertiary health care hospital.

Objective:To assess and evaluate the frequency, severity and classification of drug-related problems (DRP) resulting in hospitalization in an internal medicine department of a large tertiary care hospital and to identify any patient, prescriber, drug, and system factors associated with these events.Materials and Methods:A prospective and descriptive study carried out in Department of Medicine, Government Medical College, Jagdalpur. The DRP and relevant data were recorded on the personal record of every individual patient, filled during the course of treatment.Result:A total of 3560 patient’s records were analyzed. Among them118 admissions were due to DRP. The most common DRP noted was noncompliance in part of patient’s i.e 55 (46.6%). Statistically significant correlations were found in the number of prescribed drugs and over the counter drugs (OTC) used by patients.Conclusion:The DRP that attributed to hospital admission are mostly avoidable through proper patient education and strengthening the need of pharmacovigilance with little more vigilance in patient care.

Classification of drug-related problems with new prescriptions using a modified PCNE classification system

To explore and classify drug-related problems (DRPs) with new prescriptions detected in community pharmacies using a modified PCNE (Pharmaceutical Care Network Europe) classification system. Sixty-four Swiss community pharmacies offering internships for pharmacy students. Occurrence, nature and pharmacist's management of DRPs. Fifth-year pharmacy students collected consecutively hospital discharge and primary care prescriptions. After training, they documented clinical and technical DRPs, causes and interventions. Prescriptions of 616 patients (43.0% discharged from hospital) were analysed. The patients' median age was 56 years and they received a median of 3 (range 2-19) different drugs. In 121 (19.6%) prescriptions 141 clinical DRPs were detected. The most frequent clinical DRPs were potential drug-drug interactions (DDIs) (37.6%), drug choice (24.8%) and drug use problems (15.6%). These clinical DRPs led to a total of 299 interventions. There were 222 prescriptions (36.0%) that showed 278 technical DRPs, resulting in a total of 417 interventions. Most frequent technical DRPs were missing or unclear package size or therapy duration (32.7%) and missing or unclear dosing/application instructions (30.9%). Most DRPs (75.4%) could be managed by the pharmacist alone. The number of prescribed drugs was the main factor with an influence on the frequency of clinical and technical DRPs. Clinical and technical DRPs are frequently observed in primary care as well as in hospital discharge prescriptions. The modified PCNE classification system, especially the amendment with a technical DRP category, proved to be useful and allowed the classification of all DRPs. Neither the setting (hospital discharge vs. primary care) nor the quality of electronically printed prescriptions, but only the number of prescribed drugs influenced the occurrence of clinical or technical DRPs.

Pharmacist-documented interventions during the dispensing process in a primary health care facility in Qatar

To characterize prescribing error interventions documented by pharmacists in four pharmacies in a primary health care service in Qatar. The study was conducted in a primary health care service in the State of Qatar in the period from January to March 2008. Pharmacists in four clinics within the service used online, integrated health care software to document all clinical interventions made. Documented information included: patient's age and gender, drug therapy details, the intervention's details, its category, and its outcome. Interventions were categorized according to the Pharmaceutical Care Network Europe Classification of drug-related problems (DRP). The number of patients who had their prescriptions intercepted were 589 (0.71% of the total 82,800 prescriptions received). The intercepted prescriptions generated 890 DRP-related interventions (an average of 1.9% DRPs identified across the four clinics). Fifty-four percent of all interventions were classified as drug choice problems, and 42% had safety problems (dose too high, potential significant interaction). The prescriber accepted the intervention in 53% of all interventions, and the treatment was changed accordingly. Interventions as a result of transcription errors, legality and formulary issues were eliminated from this study through the use of computerized physician order entry (CPOE). Documenting and analyzing interventions should be a routine activity in pharmacy practice setting in primary health care services. Educational outreach visits and other strategies can improve prescribing practices and enhance patient safety.

Promoting Appropriate Drug Use Through the Application of the Spanish Drug-Related Problem Classification System in the Primary Care Setting

According to the Second Consensus of Granada (2002), the term drug-related problem (DRP) is defined as a health problem resulting from pharmacotherapy and is considered a negative clinical outcome (ie, a therapeutic objective is not achieved or adverse effects are reported). DRP classification systems used in primary care settings can be useful tools to detect, evaluate, and resolve DRPs. To encourage appropriate drug use in the ambulatory clinical setting through DRP detection and evaluation by means of the Spanish DRP classification system, and to document how pharmacists can help resolve DRPs through interventions with both general practitioners (GPs) and patients. Four pharmacists investigated DRPs in polymedicated patients over a 6-month period. All detected DRPs were grouped into 3 major categories: necessity, effectiveness, and safety. To resolve DRPs, pharmacists performed interventions on GPs and patients. GPs received verbal and written information about DRPs; patient interventions were in the form of private meetings on health education. Four hundred twenty-two patients, 80% of whom were aged 65 years or older, were included in the study. Each patient was taking a mean +/- SD of 8.1 +/- 2.4 medications. Three hundred four medications were associated with 245 DRPs; medications indicated for digestive/metabolic or cardiovascular pathologies were the most prevalent. Most (60%) of the identified DRPs belonged to the effectiveness category, whereas safety issues accounted for 28.6%. The most frequently reported DRP was pathology resistant to treatment (19.6%), followed by nonadherence (16.3%). Of the 215 interventions carried out to resolve these DRPs, 173 (80.5%) were addressed to GPs, who agreed to change therapy regimens on 90.2% of the occasions. Forty-two (19.5%) interventions were addressed to patients. Furthermore, the interventions accepted by GPs and patients resolved 176 (82%) DRPs. The current Spanish DRP classification system is a useful tool to systematically detect and document DRPs in daily general practice. In addition, the interventions addressed by pharmacists to GPs and patients resolved most of the detected DRPs.

Validation of a comprehensive classification tool for treatment-related problems

Several drug-related problem classification systems can be found in the literature. However, it is generally agreed that a comprehensive, well constructed and validated instrument is currently lacking. The aim of this study is the development and validation of a comprehensive treatment-related problems assessment and classification tool for use in teaching, practicing and researching pharmaceutical care and to improve identification, resolving and preventing of treatment-related problems. The development and validation involved five steps starting with literature search to define a treatment related problem and also to form a database of treatment-related problems identified in the literature. In the next step, all problems that were identified in the first step and passed the evaluation of the three authors were pooled together and then divided into groups according to their common or shared construct, in the third step a suitable assessment method was developed according to the construct of the different problems, in the next step the developed instrument was validated for content, internal and external validity. Finally the tool was finalized and tested for reproducibility and inter-rater agreement. The final validated version included six main categories for treatment-related problems (Indication, Effectiveness, Safety, Knowledge, Adherence and Miscellaneous). These categories include a total of nine subcategories and a total of 29 treatment related problems. The treatment-related problems assessment and classification tool introduced in this paper was applied to actual patient cases and proved to be valid. This tool also has several features that are new.

Drug-related problem classification systems.

To provide an overview of and critically appraise classifications of drug-related problems (DRPs) for use during the pharmaceutical care process and research in pharmacy. A literature search was conducted using MEDLINE and Yahoo (January 2003) and manually. The search terms included DRP, drug-related problem, drug-therapy problem, and medicine-related problem. English- and German-language articles on pharmaceutical care and DRPs were reviewed. Most classifications of DRPs were identified through searching publications on pharmaceutical care and DRPs. Fourteen classifications with different focuses were found. Some classifications were hierarchical, categorized into main groups and subgroups. Various terminologies and definitions for DRPs were revealed, as well as guidelines for an optimal DRP classification. Classifications were assessed according to a clear definition, published validation method, and results reflecting process and outcomes, usability in pharmaceutical care practice, and a hierarchical structure with main groups and subgroups. Finding DRP classifications by computerized search of the biomedical literature with the help of PubMed proved to be difficult. No classification could be found that met all of our criteria for an optimal system. Few classifications have been validated. Three have been tested as to their usability in practice and internal consistency. The Pharmaceutical Care Network Europe system Version 4 comes closest to the defined requirements.