Detection Of Drug-related Problems Research Articles

Pharmaceutical Interventions in Benzodiazepine users during the COVID-19 Pandemic

Pharmaceutical Intervention aims to optimize and rationalize the use, effectiveness, and safety of dispensed medications resolving drug-related problems (DRPs) and negative medicine outcomes (NMOs). To evaluate Pharmaceutical Interventions in Benzodiazepines users during the COVID-19 pandemic from a Community Pharmacy. Prospective observational, descriptive, and cross-sectional study (AEMPS code: DAA-CLO-2020-01) of Pharmaceutical Interventions offered by the community pharmacy between August 2020 and February 2021. A total of 306 Pharmaceutical Interventions were conducted involving 127 patients. Health education and personalized medication information were the most common Pharmaceutical Interventions after detecting a high level of unfamiliarity with the Benzodiazepines among patients. Pharmaceutical Interventions leading to medical referrals accounted for 37.8% of the total, triggered by the detection of DRPs and/or NMOs or after identifying the patient as candidate for deprescription. These referrals included patients with a very high level of depression according to the Euroqol 5D-3L test. Pharmaceutical Interventions resulting in Medication Review with Follow-up Service were performed in 3.1% of patients. The patient acceptance rate of Pharmaceutical Interventions reached 98.4%. The high acceptance rate of Pharmaceutical Interventions reinforces the value of Community Pharmacy in optimizing and rationalizing Benzodiazepines usage, while strengthening the pharmacist-patient relationship. The COVID-19 pandemic posed challenges to pharmacist-physician collaboration despite of the availability of telecommunication protocols among healthcare professionals.

Assessment of drug-related problems associated with narrow therapeutic index drugs: A prospective cohort study

Background A narrow therapeutic index drug (NTID) has a narrow window between its effective doses and doses that can cause adverse toxic effects, necessitating strict monitoring for drug safety. This study aimed to identify and classify the drug-related problems (DRPs) associated with the use of NTI drugs. Method A prospective cohort study was carried out in the in-patient departments of General Medicine, Paediatrics, Cardiology, and Neurology at a tertiary care hospital over a nine-month period. Patients of either gender receiving at least one NTID included after obtaining their consent. The patients were followed until their discharge for any DRP occurrence. The list of the NTIDs was compiled through a review of literature review and the hospital's formulary. Hepler & Strand's classification was adopted to classify the identified DRPs. The odds ratio with a 95% confidence interval was used to determine the predictors for DRP occurrence. Results A total of 241 DRPs associated with NTIDs were identified among 120 patients. Drug–drug interactions accounted for 61% of the DRPs, followed by subtherapeutic dosing (18.26%) and adverse drug reactions (9.96%). On average, each patient experienced 2.74 DRPs. The predictors for DRP occurrence included gender (odds ratio [OR] 2.65, p = .012), comorbid conditions (OR 2.947, p < .001), polypharmacy involving more than 11 drugs (OR 3.987, p < .033), and a hospital stay exceeding 7 days (OR 1.087, p = .022). Conclusion Despite providing the best therapeutic care, DRPs associated with NTIDs persist and can compromise patient safety. Therefore, involving clinical pharmacists in the early detection of DRPs can enhance overall patient safety.

Medikationsanalysen in öffentlichen Apotheken: Konzept zur externen Qualitätsüberprüfung

BackgroundA medication review aims at the optimization of medication use, the detection of drug-related problems (DRPs) and the recommendation of interventions. As part of the pilot project “Arzneimittelinitiative Sachsen-Thüringen” (ARMIN) and caused by the introduction of several training programs, numerous public pharmacies in Germany currently offer medication reviews for patients. However, a standardized method for external quality control has so far not been established. MethodsA round robin test for medication reviews was designed in written form by five pharmacists with expertise in different areas (Drug information service ARMIN, Saxonian Chamber of pharmacists, public pharmacy, hospital pharmacy), based on the recommendations of the guideline for medication reviews of the German Federal Chamber of Pharmacists (Bundesapothekerkammer). On the basis of a fictitious case study the participants were asked to check a patient's medication data for the presence of DRPs, propose possible solutions and generate a medication plan. The solutions were assessed by two pharmacists of the drug information service ARMIN on the basis of a best practice solution that had been consented in the study group beforehand. Results102 pharmacists and 13 pharmacy students in internship took part in the round robin test. On average, participants achieved a score of 7,62 out of 9 for recognizing DRPs and recommending solutions and a score of 0,79 out of 1 for generating a correct medication plan. 106 participants (92%) met the requirements for successful participation (recognizing the three most relevant DRPs and at least one further DRP as well as generating an adequate medication plan). The implementation of the approach described here proved to be practicable The State Directorate of Saxony accepted the round robin test as a measure for external quality assessment in accordance with legal requirements. ConclusionsDue to the nationwide introduction of medication reviews as a pharmaceutical service in June 2022, medication reviews performed by German community pharmacies will gain in importance in the coming years. This is why quality assurance is necessary. Since the participants‘ performance in medication analysis becomes comparable by completing the round robin test, this instrument appears to be potentially suitable for the external quality assessment of medications reviews nationwide.

Impact of pharmaceutical care in polymedicated patients admitted to a geriatric ward

The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence. Quasi-experimental, interventional study in polymedicated patients (= 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was =75%, the pharmaceutical intervention was considered to be accepted. Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP. The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient's doctor, helps to reduce the prevalence of PIP and DRP.

Assessment of the potential impact of resolving drug-related problems by clinical pharmacists in Japan: a retrospective observational study

BackgroundClinical pharmacists play a role in limiting the disadvantages of pharmacotherapy for patients by detecting and resolving drug-related problems (DRPs) through medication reviews. Although their contributions to patient care have been analyzed and understood in various countries, the role of Japanese clinical pharmacists in this context remains to be clearly elucidated. Thus, in this study, we aimed to elucidate the detection of DRPs by clinical pharmacists and determine the potential impact of pharmacist interventions in Japan.MethodsThis study was conducted in a 273-bed hospital and targeted hospitalized patients over a period of 6 months. DRPs detected by clinical pharmacists during the study period were investigated and classified into 10 types. Furthermore, medications were categorized according to the Anatomical Therapeutic Chemical classification. A review committee consisting of two pharmacists independently reviewed the pharmacist interventions on a six-point scale (extremely significant, very significant, significant, somewhat significant, no significance, adverse significance) according to the potential impact on patient care.ResultsDuring the study period, 1711 patients (mean age: 71.2 years, 54.1% male) were included, and 2149 DRPs were detected (1.26 DRPs/patient). Pharmacists intervened in all the DRPs detected. The most common DRP was supratherapeutic dosage (19.3%), followed by untreated indication (18.1%). The most common medication classification causing DRPs was “Antiinfectives for Systemic Use” (25.1%), followed by “Alimentary Tract and Metabolism” (19.9%). Most of the pharmacist interventions (99.6%) were rated “somewhat significant” or more significant, of which 1.1% were rated “extremely significant,” and none were rated as “adverse significance.”ConclusionsOur results show that in Japan, as in other countries, clinical pharmacists detect and resolve DRPs in hospitalized patients through medication review. Our findings also show that clinical pharmacists have a positive impact on patient care and suggest the need for their involvement.

Oferta de servicios de atención farmacéutica: clave para un nuevo modelo de servicios de salud

Interdisciplinary collaboration between health professionals is essential to improve health outcomes. The competences of pharmacists make them professionals capable of contributing to the comprehensive management of pharmacotherapy in collaboration with other healthcare professionals. The Council of Europe adopted resolution CM/Res(2020)3 on implementation of pharmaceutical care for the benefit of patients and health services in order to promote the appropriate and safe use of medicines. One of the activities to be carried out through the pharmaceutical care process is the detection of drug related problems, such as contraindications, duplications, prescription errors, interactions, etc. In many cases, it involves regular patient follow-up and needs an evaluation of the interventions performed, requiring the establishment of an appropriate interprofessional collaboration framework. This article discusses the issues to be addressed to face the change of model towards a care-based pharmacy.

Detection and resolution of drug-related problems at hospital discharge focusing on information availability – a retrospective analysis

BackgroundHospital stays are often associated with medication changes, which may lead to drug-related problems (DRPs). Medication reconciliation and medication reviews are strategies to detect and resolve DRPs. MethodsA descriptive cohort study was conducted using DRPs collected during routine pharmacist-led medication reconciliation and medication reviews in the hospital's community pharmacy at discharge (Zug Cantonal Hospital, Switzerland). In a simulation experiment, we retrospectively analysed the detection and resolution possibilities of these DRPs and their dependency on different information sources. ResultsOverall, 6,087 prescriptions were filled in the hospital's community pharmacy (between June 2016 and May 2019). Among 1,352 prescriptions (with ≥ 1 documented DRP) a total of 1,876 DRPs were detected. The retrospective assessment showed that 1,115 DRPs could have been detected by performing simple medication reviews (based on the discharge prescription and the medication history), whereas in the remaining cases, additional clinical and/or patient-specific information would have been needed. In 944 (84.7 %) DRPs, which are detectable by simple medication reviews, the pharmacist would need to consult the prescriber for resolution. ConclusionThe detection of DRPs is strongly influenced by the information available. These results support models with pre-discharge medication reconciliation and pharmacist-led medication review procedures enabling both comprehensive detection and facilitated resolution of DRPs.

Expert Consensus on a List of Inappropriate Prescribing after Prescription Review in Pediatric Units in Abidjan, Côte d'Ivoire.

IntroductionInappropriate prescribing (IP) includes inappropriate prescription and omission of prescription. IP can adversely affect the quality of health care in pediatric units. A list of IP taking into account frequently encountered drug-related problems (DRPs) can be useful to optimize prescriptions in pediatrics. The aim of this study was to validate by expert consensus a list of IP after a prescription review in pediatric units in Abidjan.Materials and MethodsA list of IPs was developed from a prescription review of inpatients and outpatients aged 1 month to 15 years and followed in pediatric units at teaching hospitals of Abidjan during 16 months. A two-round Delphi method was used to validate a qualitative list of IPs by experts according to their level of agreement on a six-point Likert scale of 0–5 (0, no opinion; 5, strongly agree). Only propositions obtaining the agreement (rating 4 or 5) of >70% of experts who gave a non-zero rating for the first round and 80% for the second round were retained.ResultsA qualitative list of 54 IPs was drawn up from 267 DRPs detected after prescription review of 4,992 prescription lines for 881 patients. Our panel comprised 22 pediatricians (96%) and one clinical pharmacist (4%). Mean agreement ratings were 4.43/5 (95% CI 4.39–4.48) and 4.6/5 (95% CI 4.56–4.64), respectively, during the first Delphi round and the second (p<0.001). At the end of the first round, all items submitted (54) were retained, including 13 items that had been reworded. In the second round, 20 experts participated and two IPs (4%) were not retained for the final list. This list comprised 52 IPs (44 inappropriate prescriptions and eight omissions of prescription).ConclusionThe list of IP validated in this study should help in the detection of DRPs and optimize prescriptions in pediatric units in Côte d’Ivoire.

Antimicrobial stewardship solutions with a smart innovative tool

BackgroundAntimicrobial consumption has been increasing lately. Hence, effective strategies are required to control antimicrobial use and decrease the development of antimicrobial resistance. ObjectiveTo evaluate the impact of the use of a mobile app on the implementation of antimicrobial stewardship program (ASP) interventions. MethodsThis was a longitudinal study conducted at El-Nile Badrawi Hospital in Cairo, Egypt, on inpatients receiving antimicrobials from January 2018 to December 2019. The study included 2 phases: the preimplementation phase, which included a paper-based ASP developed according to the Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship Programs 2014, and the mobile app phase where the MEDIcare Pro mobile app was developed and used in ASP intervention implementation. The study outcomes were antimicrobial consumption and cost, length of hospital and intensive care unit (ICU) stay, 30-day mortality rate and readmission rate, and detection of drug-related problems (DRPs). ResultsThe mobile app statistically significantly decreased antimicrobial consumption from 75.1 defined daily dose (DDD)/100 bed-days in the preimplementation phase to 64.65 DDD/100 bed-days in the mobile app phase, with a total cost savings of E£1,237,476. There was a significant reduction in the length of ICU stay, with a mean difference of 1.63 days between the 2 phases, but no significance was detected regarding length of hospital stay or readmission rate. There was a statistically significant decrease in mortality rate from 1.17% in the preimplementation phase to 0.83% in the mobile app phase (P = 0.02). The frequency of DRPs detected by pharmacists statistically significantly increased from 0.54/100 bed-days in the preimplementation phase to 3.23/100 bed-days in the mobile app phase. ConclusionThe use of a mobile app was found to be effective, applicable, and usable in guiding health professionals on rational antimicrobial use.

The Impact of an Established Pharmaceutical Care Pathway on Drug Related Problems in an Intensive Care Unit

BackgroundThe incidence of drug related problems (DRPs) in intensive care units (ICU) is higher compared to any other wards in the hospital, requiring a structured pathway to ensure optimum detection of DRPs. The study aimed to evaluate the impact of implementing a pharmaceutical care pathway on the detection and management of DRPs in an ICU. MethodsThe study was conducted in a general ICU and included three phases: tool preparation phase included the development of a core measures reference pathway and daily working scenario flow-charts, a control phase where the patient files and pharmacists' case assessment notes were retrospectively reviewed to detect the rate of DRPs before pathway implementation and a prospective phase similar to the control phase but with the implementation of the new pathway. The number and classification of DRPs and required core measures in the control and implementation phases were documented. ResultsUsing the new pathway, the detection of unmet core measures increased from 7.3% in the control phase to 99% in the implementation phase (p-value <0.001). The prevalence of unidentified DRPs/1000 patients' service days decreased from 98.1 in the control phase to 27.08 in the implementation phase (p-value <0.001). However, there was no significant difference between the phases regarding mortality rate and length of ICU stay. ConclusionsThe implementation of a unified pharmaceutical care pathway improved the detection of DRPs in ICU patients.

Frequency and nature of drug‐related problems in patients with acute coronary syndrome: role of the clinical pharmacist in coronary care practice

AbstractBackgroundPatients with acute coronary syndrome (ACS) often have associated problems either as a reason or as a corollary of the disease and drug‐related problems (DRPs) are more likely to precipitate despite the presence of standard guidelines. This research is intended to evaluate the nature and extent of DRPs and examine their clinical significance in the presence of a clinical pharmacist.MethodsA clinical pharmacist‐initiated cross‐sectional study was carried out in the Department of Cardiology unit in a tertiary care teaching hospital for a year. The patient's medications were audited for DRPs using PCNE V 8.0.1 and drug‐interactions by Micromedex. Descriptive and inferential statistics were applied whenever required by using SPSS v 25.0.ResultsA total of 1120 patients screened, 432 patients were enrolled in the study by obtaining consent. The majority were in the age group 41–60 years of whom (294 (68.05 %)) were males. DRPs (367) were identified in (225 (52%)) patients of which (243 (66.13%) were due to problems in prescription, 27 (1.90%) treatment duration, followed by dispensing 43 (11.71%), drug use process 41 (11.17%) and patient‐related 38 (10.35%)). The overall incidence of DRPs was 51.85%. Most risk factors were associated with DRPs (p &lt; 0.0001).ConclusionDrug‐related problems are common in patients with acute coronary syndrome due to comorbidities and its related polypharmacy. Physician and clinical pharmacist collaboration can help in the early detection of DRPs, and alleviate the adversities emphasising optimal pharmacotherapeutic management.

Retrospective analysis of adverse drug reaction reporting forms associated with penicillin family antibiotics (pcne-drp 9.0) based on drug-related approach

A widespread use of β-lactam antibiotics such as penicillins in practical medicine, and its authorized use in special categories of patients (e.g. children, pregnant and lactating women, the elderly) requires a critical investigation of their safety as well as the obligatory risk assessment before conducting antibacterial pharmacotherapy.The aim of the work was the conduction of a retrospective study of adverse reactions cases, the identification and analysis of drug-related problems (DRP) associated with the use of penicillin family antibiotics.Materials and methods. The objects of the study were adverse drug reactions (ADR) associated with the use of penicillin family antibiotics in inpatient and outpatient facilities, as well as the cases of self-treatment, which were recorded in the official ADR reports and then inputted in the regional (Republic of Crimea) database of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). The covered period is 2009–2018. The analysis of DRP was carried out using the 9.0 version of the qualification system DRP PCNE (Pharmaceutical Care Network Europe Foundation).Results. The data analysis of ADR reporting forms has revealed that Amoxicillin clavulanate and Amoxicillin were the most frequent cause of ADR. A high incidence of penicillins ADR in pediatric patients (from 0 to 18 years) – 142 cases – has been found. The clinical manifestations of reactions included drug hypersensitivity reactions (309 cases), dyspeptic disorders (28 cases) and disorders of the central nervous system (5 cases). The incidence of serious ADR was 113 cases (33% of the total number of ADR in the study), which indicates a rather high risk of developing severe ADR for penicillins, resulted in a significant decrease in the quality of patients’ lives.Conclusion. The detection of DRP using the PCNE V9.0 approach is a useful and promising tool important to improve the quality of pharmacotherapy and their adherence to treatment. The highest DRP values which were observed for Amoxicillin clavulanate and Amoxicillin, may indicate a high frequency of irrational use of these drugs.List of abbreviations: DRP – drug related problems; ADR – adverse drug reactions; INN – international non-patented name

Impact of Pharmacist Interventions in an Ambulatory Geriatric Care Clinic: The IMPACC Study.

To compare the impact of a pharmacist's presence for the detection of drug-related problems (DRP) in an interdisciplinary geriatric-ambulatory clinic with a control group without a pharmacist.<br/> DESIGN: Retrospective quasi-experimental study.<br/> SETTING: A geriatric ambulatory-care clinic of a 772-bed tertiary-care teaching hospital in Montreal, Canada.<br/> PARTICIPANTS: A total of 227 ambulatory patients 65 years of age and older presenting to their appointment at the geriatric ambulatory clinic between May 1, 2018, and April 30, 2019.<br/> MAIN OUTCOME MEASURE(S): DRP detected by the interdisciplinary team during the patient evaluation process. Data were collected from clinical notes written by the health care professionals in the electronic medical chart.<br/> RESULTS: The mean age was 80.8 years, and 60.8% of the population were female. Patients were prescribed a mean of 11.3 medications at home. Overall, 636 DRP were detected in the study population. In the adjusted analysis, the difference between the two groups was 2.7 (95% confidence interval 2.0-3.3) DRP detected favoring the group with a pharmacist.<br/> CONCLUSION: The inclusion of a pharmacist in an interdisciplinary team in an ambulatory geriatric-care clinic was associated to a positive impact on care by substantially increasing the number of DRP detected in older patients.

Assessment of Drug Related Problems among Type 2 Diabetes Mellitus Patients with Hypertension in Doloksanggul Hospital, North Sumatera: A Retro prospective Study

Objective: The aim of this study was to assess the drug-related problems (DRPs) in Type 2 diabetes mellitus(T2DM) patients whom also diagnosed with hypertension. Methods: The retrospective study was conducted from October to December 2018 at Doloksanggul Hospital in North Sumatera, Indonesia involving 42 T2DM with hypertension patients according to research inclusion criteria. The assessment of DRPs was based on the Pharmaceutical Care Network Europe (PCNE) tools version 8.01. Results: This study identified 41 DRPs, averaging 0.98±0.24 DRPs per patient. The majority of problems were treatment effectiveness problems 97.62% (41 patients) while the patient related was the main causes (47.24%). The most intervention was conducted at patient level (71.62%).Conclusion: Early detection of DRPs by pharmacist are essential to prevent DRPs and to ensure the effectiveness of drug therapy.&#x0D;

Development of a pharmaceutical care program in progressive stages in geriatric institutions

BackgroundTo introduce and manage a Pharmaceutical care programs in geriatric care institutions presents difficulties such as reduced pharmacy service staff, complexity of the patients or lack of integration of the pharmacist in the health care team. This work describes the evolution of the implementations of a program of pharmaceutical care centered in drug related problems (DRP) in a group of geriatric institutions of different levels of complexity.MethodsSetting: Long-term and subacute care hospitals (HSS) and Health care teams attending nursing homes (EARs).Participants: Patients attended in HSS and EARs during different periods between 2010 and 2016.Interventions: The program was developed in different stages, in which pharmacists made interventions of increasing complexity.ResultsBetween 2010 and 2013, the approach was only to improve the prescription of non-appropriate drugs for the elderly, which was reduced from 19 to 14.5%. Subsequent steps included detection of drug-related problems (DRP), systematization of treatment revisions, recording of pharmacist interventions, improvements in the classification of interventions and the creation of a web-based database for recording in a more efficient way.During these years, there was an increase in the number of patients included in pharmaceutical care activities and thus the number of pharmacist interventions (3872 in 2014 vs 5903 in 2016). In 2016, mean age in 2016: 83.2 years old. Mean number of medicines/patient: 8.4 ± 3.3, and mean interventions/patient: 1.62. Degree of acceptance of the interventions by physicians improved (68.6% in 2016 vs 45.5% in 2012), even though there is still much work to do.The Medication Appropriateness Index (MAI) showed that when the interventions were accepted, there was an important improvement. HSS mean MAI values pre-intervention: 2.52, post-intervention 0.80. In EARs: 5 pre and 1.39 post. In both cases p < 0.0001.ConclusionsApproaching the deployment of activities in a progressive way has made us more efficient and able to confront and solve the problems that have arisen. Even though there has been a very restricted increase in the staff and budget, we are able to implement a DRP detection programme with guaranties of quality.

Pharmacists in general practice: a focus on drug-related problems.

Background Team based care has been used internationally to improve the delivery of best practice primary health care. The WentWest General Practice Pharmacist Project, involving the integration of pharmacists within general practice teams, was commissioned to improve medication management of general practice patients. A particular focus of the project was the performance of medication review to allow the detection and resolution of drug related problems (DRPs). Objective The objectives of this 6-month study (October 2016-March 2017) were to: (1) identify and classify the DRPs detected as a result of pharmacist activities within a general practice primary care setting. (2) compare the number of pharmacist recommendations and GP acceptance rates as a result of pharmacist patient consultations across multiple general practice sites. Setting 15 general practice primary care sites in Western Sydney NSW Australia. A multi-centre prospective observational study conducted over a 6-month period from October 2016 to March 2017. Main outcome measure Drug-related problems (DRPs). Results Six pharmacists recorded the results from 493 patient consultations. The pharmacists identified 1124 DRPs and made 984 recommendations, of which 685 (70%) were recorded as accepted by the GP. Conclusion Pharmacists have a valuable role to play in the detection and resolution of DRP as part of the general practice team.

Economic evaluation of the integration of a pharmacist in the primary care home-based care team

In Spain, primary care teams -made up of a nurse and a general practitioner (GP)- provide home-based care for complex patients with chronic severe conditions that impede them from accessing to the primary care centre. These patients are usually polimedicated and highly disabled. Usually, a patient's relative provides is responsible of providing help with the management of their medications. Including a pharmacist in the home-based care team could improve the detection of drug-related problems and improve patient care. Taking into account the high costs that these patients generate to the system, we hypothesized that the pharmacist could be introduced as part of the team at a relatively low cost. Chronic and complex patients with mobility problems from the primary care centre Montnegre were included in the service. The home-based care at the PC Montnegre is usually provided by two teams of GPs and nurses. Three pharmacists were integrated in these teams. Prior to the home visit, the team reviewed the patients' clinical history (health problems and medication). At the patients' house, the pharmacist reviewed the patients' medication (prescription medicines and over-the-counter medication). Then, the pharmacist searched for drug-related problems and suggested interventions to the GP and nurse to stop or prevent future harm to the patient. The GP and nurse evaluated the appropriatness of the suggested interventions. Use of services was assessed using the patients electronic records. Information was gathered on costs for the public health system (visits to primary care, secondary care, hospitalisation and tests). Cost of the pharmacist was calculated taking into account the hours spent on the patients' house and reviewing the patients' clinical history and medication. The service was provided to 50 patients. Mean age was 86.3 years old. All but one of the patients had an informal carer. Health related quality of life was low (mean EQ-5D tariff=0.38) and patients took a mean of 9.4 different drugs. The pharmacists identified a mean of 5.1 drug-related problems per patient and suggested 143 interventions (most commonly monitoring the evolution of a biochemical parameter [44.1% of interventions] and removing or adjusting the dose of a medicaiton [41.3% of interventions]). Overal, 75.5% of the suggested interventions were accepted by the team of GPs and nurses. The overall mean cost per patient in 6 months was of 3,533.8€. The mean cost per patient of the pharmacist was 116.4€, representing an 8.7% increase in the total cost of the patient. Patients requiring home-based care are complex patients that generate a high burden to the health system. Although these patients are under close medical supervision, the integration of a pharmacist in the team of home-based care led to the identification of a number of drug-related problems. The relative cost of including a pharmacist as part of the team of hom-based care was low. In Spain, pharmacists provide ambulatory care in privately managed community pharmacies and are not seen as a part of the health system structure. This difficults the coordination with the primary care teams and was the main barrier for collaboration within the team. Future studies should evaluate the factibility and efficiency of integrating a pharmacist in the home-based care team using a control parallel group and a longer follow up.

Multidisciplinary teams involved: detection of drug-related problems through continuity of care.

To quantify Drug-Related problems (DRPs) by establishing a Strategic Continuity of Care Program (e-Conecta- Concilia Program; e-CC) focused on the drug therapy of patients within an Integrated Management Structure, in order to guarantee the therapeutical efficiency, safety and traceability of patients. A prospective study at 8 months. The project included 22 Hospital Pharmacists and 12 Primary Care Pharmacists. Electronic clinical records were used, which can be accessed by all healthcare levels. Those interventions required in order to create a Standard Operating Procedure (SOP) were carried out (creation of working groups, computing, meeting points), for coordination among pharmacists in different care levels through a common communication system. The working groups formed by pharmacists of both care levels established the following inclusion criteria: patients with chronic diseases and polymedicated, patients for whom drug-related problems (DRP) had been detected, detection of any off-label use in Primary Care, or discrepancies in the standardization of medical prescriptions. In the setting of the e-CC program, interventions were unified and discrepancies were identified. During this project, 245 drug-related problems were detected; the majority regarding inadequate dosing, regimen, or duration (24%), and involving Group B medications (33%), according to the ATC classification. The implementation of a Continuity of Care SOP between pharmacists allowed to detect and solve DRPs and discrepancies in patient pharmacotherapy, with a high rate of acceptance (84.1%) of interventions.

Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud.

To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd.

Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction

Self-administration of oral chemotherapy regimens in the home setting leading to new challenges in the health system. To develop and evaluate a comprehensive pharmaceutical care program for cancer outpatients treated with oral antineoplastic agents. A Spanish tertiary hospital. During 2012, a comprehensive pharmaceutical care program was elaborated following the standards recommended by ASCO. It comprised a standard procedure focusing on: drug indication, dosing regimen, required laboratory tests, route of administration, interactions with other current medications and adverse events; a checklist and informational brochures. A pharmaceutical follow up was defined and structured into three clinical interviews over 6 months which focused on safety and efficiency outcomes. Patients starting treatment with oral antineoplastic agents during 2011 (control group) without pharmacist monitoring were compared to patients beginning treatment at some point in 2013 who were prospectively monitored by a pharmacist (intervention group). Statistical analysis was performed by the statistical program SPSS, 21.0 and p < 0.05 was considered significant. Patient demographics and clinical data were recorded. The primary endpoint was safety outcomes: detection of drug related problems, drug interactions, and adverse events. Adherence, permanence and patient satisfaction were also collected. A total of 249 patients were enrolled in the study. Two hundred and seventy-five medication errors were recorded [106 in the control group and 169 in the intervention group (p = 0.008)]. The pharmacist intervened in 362 occasions being accepted 88.8 % of the time, mainly to reinforce patient education and literacy and giving information on co-administration with other drugs and herbal medicines. Adherent patients increased at the 6th month of treatment in the intervention group by 20 % (p < 0.001). High satisfaction was reported. The program has been implemented and evaluated successfully. It ensures a high quality and standard of pharmaceutical care with high patient satisfaction rate and the key points to prioritize for improvement in terms of safety (interactions and administration errors) and efficiency (adherence and permanence) of oral antineoplastic agents.