Frequency Of Drug-related Problems Research Articles

Frequency and risk factors for the development of drug related problems among rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) patients are at high risk for development of drug related problems (DRPs) due to multiple drug use. This study aimed to estimate the frequency and risk factors for the development of drug related problems among RA patients in Indian setting. MethodsA prospective cohort study was carried out for twenty-two months in a tertiary care teaching hospital. Patients who met study eligibility criteria were randomised either into intervention or usual care group. All the patients’ data were screened for the presence of DRPs. Identified DRPs were categorized into problems and their causes using Pharmaceutical Care Network Europe (PCNE V8.02) DRP Classification system. Clinical pharmacists proposed interventions to resolve DRPs in intervention group. ResultsA total of 320 RA patients [Intervention group, n = 160 and usual care group, n = 160] were enrolled in this study. Overall, 463 DRPs were identified among 88.4% of patients, and frequency of DRPs was 1.6 per patient. Treatment safety (41.2%) and patient related factors (28.2%) was the most common category and cause of DRPs respectively. Advanced age and polypharmacy were the common risk factors identified for the development of DRPs. ConclusionThis study revealed DRPs are common among RA patients and those are related to the treatment safety and efficacy. Clinical pharmacists’ provided interventions had significant impact on DRPs resolution among RA patients.

Characteristic of drug-related problems and pharmacists' interventions in a stroke unit in Thailand.

Background Little information is available regarding pharmacist's intervention to solve drug-related problems (DRPs) in a stroke unit. Objective To investigate the nature and frequency of DRPs along with the role of pharmacists in a stroke unit. Setting The study was conducted at the stroke unit of Siriraj hospital, a university affiliated tertiary care hospital in Thailand. Method A retrospective descriptive study of DRPs and pharmacists' interventions for stroke patients was performed during July 2015 to December 2016. Data were collected from patient's medical records and pharmacist's intervention record forms. DRPs were categorized using the Hepler-Strand classification. The stroke pharmacist team, consisting of a board-certified pharmacotherapy specialist, neurology pharmacy residents and stroke unit pharmacists, participated in the multidisciplinary ward round in the stroke unit 5days a week. All patients were visited by a member of the stroke pharmacist team within the first two days of their admission to conduct a thorough review of drug therapy for every patient and provided appropriate recommendation to the multidisciplinary team either verbally during the ward round or with written information in the patients' medical charts, as appropriate. Main Outcome Measure (a) incidence and characteristics of DRPs (b) types and the acceptance of pharmacists' interventions. Results A total of 859 patients were admitted, of those, 768 patients had ≥ 1 DRPs and a total of 796 DRPs were identified. Clinical pharmacists provided 659 interventions to the multidisciplinary team. The most common DRPs identified were "untreated indications" (22.6%) and "non-compliance" (21.0%). Of all DRPs, 74.6% were stroke related issues. The most implicated drugs were antihypertensive drugs, followed by antithrombotic therapies. The multidisciplinary team accepted 84.7% of pharmacists' interventions. Conclusion DRP in a stroke unit is common. Clinical pharmacists in a stroke unit can effectively reduce and prevent DRPs with the focus on performing medication reconciliation, providing recommendation on dosage adjustment and proper drug selection for stroke patients.

A study to assess drug related problems in patients with Cardiovascular Diseases in a tertiary care teaching hospital

Back ground: Drug related problems are common in hospitalized patients and may lead to increase hospital stay, health care cost and augment the risk of morbidity and mortality. Objective: The aim of the study is to examine the nature and frequency of drug related problems, to minimize drug related problems and to improve therapeutic outcome by pharmaceutical care provided by clinical pharmacist. Methodology: A prospective study was conducted in the cardiology department of a tertiary care hospital over a period of six months. Necessary demographic and clinical data was collected from the case records including drug history, other relevant details of the admitted patients and reviewed by the clinical pharmacist for drug related problems. Results: A total of 280 patient case sheets were reviewed during the study period, out of which 244 drug related problems were identified. The most common drug related problem was found to be drug interactions (58.6%) followed by untreated indication (19.26%) and drug use without indication (15.57%). The most frequent suggestions provided by the intervening pharmacist were drug discontinuation (5.32%), addition of a new drug (5.32%) and change of dosage form (4.5%). Conclusion: Drug related problems are common among medical ward patients. Routine participation of clinical pharmacist in clinical medical rounds facilitates the identification of drug related problems and the current study highlights the importance of pharmacist in a multidisciplinary team of reviewing drug therapy for identification and resolution of DRPs which helps in achieving better therapeutic outcomes and improved patient care. Keywords: cardiovascular diseases, clinical pharmacist, dyslipidemia, drug related problem.

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.

Drug related problems and pharmacist interventions in a geriatric unit employing electronic prescribing

Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent drug related problems (DRPs). The primary objective was to make an inventory of the DRPs and resident pharmacist on-ward interventions (PIs) identified in a geriatric acute care unit using CPOE system. The secondary objective was to evaluate the physicians' acceptance of the proposed interventions. A 26-bed geriatric ward of a 1,300-bed teaching hospital. A 6-month descriptive study with prescription analysis and recommendations to physicians by a resident pharmacist during five half days a week. Patients' characteristics, number of prescribed drugs per patient, nature and frequency of DRPs and PIs, physicians' acceptance and drugs questioned. Resident pharmacist reviewed 311 patients and identified 241 DRPs. One hundred and fifty-two patients (49 %) had at least one DRP (mean ± SD age 87 ± 6 years, mean ± SD number of prescribed drugs 10.7 ± 3.4). Most frequent DRPs were: untreated indication (n = 58, 24.1 %), dose too high (n = 46, 19.1 %), improper administration (n = 31, 12.9 %) and drug interactions (n = 23, 9.5 %). The rate of physicians' acceptance was 90.0 % (7.5 % refusals, 2.5 % not assessable). DRPs related to CPOE system misuse (n = 35, 14.5 %) appeared as a worrying phenomenon (e.g., errors in selecting dosage or unit, or duplication of therapy). A resident pharmacist detected various DRPs. Most PIs were accepted. DRPs related to the misuse of the CPOE system appeared potentially dangerous and need particular attention by healthcare professionals. The description of the DRPs is an essential step for implementation of targeted clinical pharmacy services in order to optimize pharmacists' job time.

Drug-related problems in prescribed medicines in Germany at the time of dispensing

Drug-related problems (DRPs) can have an important impact on the effectiveness and safety of pharmacotherapy. In Germany, the frequency of DRPs in prescribed medicines in ambulatory care is not yet known. Objective To quantify DRPs in prescribed medicines identified by community pharmacists (CPs) at the time the medicine is dispensed. German CPs in four different regions. We invited CPs to document one hundred consecutive patients presenting prescriptions using a standardized documentation form. For each patient, person- and medication-related as well as identified DRP-related data were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed. Nature and frequency of DRPs. In total, 143 CPs documented 14,231 patients with 24,422 prescribed drugs and identified DRPs in 2,556 patients (18.0%). Analyses resulted in 0.23 DRPs per patient and 0.13 DRPs per prescribed medicine. Four DRPs were responsible for almost 70% of all DRPs: Potential drug-drug interaction (22.9%), dose not known to patient (21.7%), patient insecure due to generic substitution (13.5%), and insufficient patient knowledge of correct drug use (10.9%). If a patient's drug file was kept in the pharmacy, specific types of DRPs were detected more frequently e.g., drug-drug interactions (p < 0.001). Interventions primarily comprised counselling, monitoring, and changing drug or instructions for use. The prescribing physician was contacted in 28% of DRPs resulting in a change of these prescriptions in 50% of the cases. Overall and according to the pharmacists, more than 90% of the DRPs detected were partially (10.4%) or completely (85.4%) solved. We quantified DRPs in prescribed medicines in daily ambulatory care practice in Germany. When filling a prescription, in nearly 20% of the patients relevant DRPs were revealed. According to the pharmacists, the majority could be partially or completely solved during the encounter at the pharmacy. Keeping a patient's drug file including patient specific data may facilitate the detection of DRPs and shall, therefore, be offered to patients more often.

Identifying drug-related problems during transition between secondary and primary care in New Zealand

The purpose of this study was to identify the type and frequency of drug-related problems (DRPs) that are encountered when dispensing secondary care prescriptions in community pharmacy. A cross-sectional study was conducted attempting to recruit all patients presenting with secondary care prescriptions to a single community pharmacy in New Zealand over a 3-month period. The DRPs were recorded to allow analysis of the types and frequencies of the problems seen. During the 3-month period 401 patients consented to participate and 840 prescription items were analysed. DRPs were identified in 20% of prescription items analysed (n = 172), affecting 38% patients (n = 155). Bureaucratic interventions concerning product availability and payment issues accounted for 55% and affected 11% of the prescription items analysed. The remaining 45% of DRPs concerned clinical and patient issues and affected 9% of prescription items. This study has shown that the secondary-primary interface is problematic with respect to DRPs. Although pharmacists are in a position to identify and act on these DRPs, access to basic patient notes such as a discharge summary and including pharmacists in the communication between secondary and primary providers should assist in achieving seamless care for the patient and help to identify and prevent DRPs.

Identification of Drug-Related Problems: A Prospective Study in Two General Hospitals

Drug-related problems (DRPs) can reduce the potential clinical benefits of treatment with medicines and waste valuable resources. No previous studies were published to examine the nature and frequency of drug related problems among hospitalized patients in Palestinian hospitals. Prospective observational study was conducted to report and record the natural and frequency of drug related problems in two general hospitals. The study included 212 patients, 54.4 % female, with a mean age 62.2 (±10.6 SD). 88% of the patients were reported with one or more DRPs, with an average of 1.9 DRPs per patient were found. The most prevalent DRP was incorrect dosing regimen which was represented by (22.2%), followed by drug-drug interaction (19.4%), drugs need laboratory tests (15.2%). Ceftriaxone, warfarin, enoxapirin and dogixin were the drugs causing most frequent DRPs. The drug groups causing most DRPs were anti-infective agents, anti-thrombotic agents and non-steroidal anti-inflammatory agents. Once discovered, the majority of DRPs (71.6%) were accepted by the physicians and solved immediately, while 11.5 % of pharmacist advice was not approved. Multiple regression analysis indicated that the number of medications (RR 1.99; 95% CI 1.31-3.76) and the number of medical conditions (RR 1.81; 95% CI 1.11-3.13) independently predicted the number of DRPs. DRPs in general hospitals are frequent, serious and predictable. Most of the problems identified as DRPs by the pharmacists were accepted by the physicians and solved. Pharmacists in the hospital setting are well suited to identify and resolve DRPs.

Drug-related problems in patients with ischemic stroke in hospital

Drug therapy is getting more complex, thus making it more challenging to prescribe appropriate drug therapy. Accordingly, in clinical practice, a wide range of drug-related problems (DRP) may arise; they are relatively common in hospitalised patients and can result in patient morbidity and mortality, and increased costs. The objective was to investigate the nature and frequency of DRPs along with pharmaceutical interventions to address them in patients with ischemic stroke from hospital admission to discharge. From January to June 2011 patients with ischemic stroke, who were taking >2 drugs during hospital stay and at discharge, were recruited. A clinical pharmacist performed medication reconciliation on admission, and checked the medication records during the hospital stay regularly. DRPs were categorized by APS-Doc. Results In total, DRPs occurred in 105/155 (67.7 %) patients: Overall 271 DRPs were documented, with a mean of 1.8 ± 2.0 DRPs per patient. The DRPs occurred mainly in the categories "drug", "indication", and "dosage". In conclusion, DRPs are relatively common in hospitalised patients and may occur at any part of the prescribing process. The clinical pharmacist can provide a valuable contribution in the multidisciplinary team to an optimized pharmacotherapy in patients with ischemic stroke.

Comprehensive evaluation of clinical pharmacists' interventions in a large Austrian tertiary care hospital

Objectives To analyse drug-related problems (DRPs) and describe clinical pharmacists' interventionsMethod A prospective 22-week observational descriptive clinical pharmacists' intervention study on six different wards of an Austrian tertiary care university...

Causes of drug-related problems in the emergency room of a hospital in southern Brazil

Objective To assess the frequency and types of drug-related problems (DRPs) in patients seeking emergency care in a teaching hospital in southern Brazil and to identify the possible causes and drugs involved in these problems. Method A cross-sectional study was performed, using a structured questionnaire for data collection. Multivariate logistic regression was used to control for possible confounding factors and to establish an independent association between the presence of DRPs and the amount of medication, patient's age and their educational level. Results A total of 350 patients were interviewed. The frequency of DRPs was 31.6%. Quantitative ineffectiveness was observed in 30.9% of DRPs and the main cause of the DRP was an inadequate dosing regimen. Sixty-six DRPs (53.7%) were caused by the health system or the health professionals. Factors independently influencing the development of DRPs were educational level and the number of drugs being taken. Conclusions Our data suggest that one-third of the patients attending the emergency room of our hospital had a drug-related problem, highlighting the importance of considering drugs as a possible cause of health problems and the need for their more rational use.

Drug-related problems in diabetes and transplant patients: an observational study with home visits

To get insight into the medication management of diabetes type 2 (DM) as well as solid organ transplant (Tx) patients and to analyse drug-related problems (DRPs) in order to explore opportunities for the provision of pharmaceutical care. Seventy-nine Swiss community pharmacies offering internships for pharmacy students. Diabetes and transplant patients were recruited in community pharmacies and were interviewed at home by fifth-year pharmacy students who were supervised by a trained investigator, using a specific interview guide developed for this study. Pattern and frequency of DRPs and pattern of medication management. In total, 22 (Tx patients) and 54 (DM patients) home visits were carried out. Mean age of visited patients was 71.4 ± 8.1 years (DM) and 52.6 ± 13.8 years (Tx). Overall, 37.0% (DM) and 50.0% (Tx) of participants were female. We identified 7.4 ± 2.4 (mean ± SD) DRPs per visited patient, with considerable differences between Tx and DM patients (6.3 ± 1.7 vs. 7.8 ± 2.5). The most frequent DRPs were risk for non-adherence (DM: 61.1%; Tx: 77.3%), confusion of generic and trade names (DM: 74.1%; Tx: 27.3%), hoarding of over-the-counter medicines (DM: 48.1%; Tx: 4.5%) and prescription-only medicines (DM: 37.0%; Tx: 36.4%), gaps in knowledge about potential interactions (DM: 61.1%; Tx: 18.2%) and purpose of drugs (DM: 48.1%; Tx: 36.4%). Mean (SD) duration of the visits was 51.7 ± 21.4 min. Visiting Tx and DM patients in their homes allowed the identification of a wide range of opportunities for pharmaceutical care as well as specific DRPs which most probably would have escaped a medication review in the pharmacy.

Role of the pharmacist in a presurgical clinic designed to optimize outcomes after elective total joint arthroplasty

It is well documented that clinical pharmacists who provide pharmaceutical care reduce the frequency of drug-related problems (DRPs) and that optimization of drug therapy in this way may influence health expenses, patients’ quality of life, and mortality rates.[1][1],[2][2] It is common for

Evaluación de la calidad de dos modelos de atención farmacéutica en pacientes onco-hematológicos

To compare the quality of two pharmaceutical care models (with and without pharmacist participation in the clinical team), in hospitalised onco-haematological patients. A prospective cohort study in the oncology and haematology departments of a university hospital over a 26-month period. A centralised model (model C) was used over 16 months and a decentralised integration model (model D) was used during the remaining 10 months. The Iaser (c) methodology was used to identify candidates for improved drug treatment and for the follow up of patients with drug-related problems (DRP). The results obtained were compared using a series of pharmaceutical care quality indicators. The rate of patients identified with DRP increased significantly (RR = 2.3; CI 95%: 1.8-2.8), as did the frequency of DRP (RR = 3.4; CI 95%: 2.8-4.0), in particular the frequency of preventable DRP (RR = 3.8; CI 95%: 2.5-4.2). The identification of the type of DRP relating to indication significantly increased (RR = 4.5; CI 95%: 3.4-5.8), followed by DRP relating to efficacy and safety. The acceptance of pharmaceutical care interventions did not improve proportionally (RR = 1.0; CI 95%: 0.9-1.1), although there was a significant increase in practices with clinical importance (RR = 4.1; CI 95%: 3.3-5.0), that showed an objective or subjective decrease in the risk of drug-related morbidity in patients (RR = 4.1; CI 95%: 3.1-5.4). Pharmacist participation in the interprofessional team improved the quality of pharmaceutical care, in particular with respect to the increased identification of possibilities to improve drug treatment and clinically significant pharmaceutical practices. As a result, the risk of drug-related morbidity can be reduced in patients.

Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic

To describe the scenario and frequency of drug-related problems (DRPs) in in-patients and to determine whether a pharmacotherapeutic advisory intervention aiming at reducing DRPs could affect rates of re-hospitalisation and/or death within 6 months. This prospective, randomised, controlled advisory intervention study was carried out at the Clinic of Internal Medicine at Stockholm Söder Hospital. Three hundred patients from four wards took part in the study. Patients taking two drugs or more were included. In the intervention arm, potential drug interactions were found using a computer system. Medical symptoms were estimated by a nurse together with the patient. Creatinine clearance was calculated. Thereafter a clinical pharmacologist scrutinised the patient s medical record for DRPs together with the nurse. DRPs judged to be clinically relevant resulted in written advice to the physician in charge of the patient. The control group received usual care. In the intervention group, a total of 299 DRPs were found among 71% of the patients (106/150). The number of written letters of advice to the physicians in charge was 106. Of these, 63% were accepted. After 6 months, the proportion of re-hospitalisations or death in the intervention group was 49% (73/150) compared to 46% (69/150) in the control group. The difference was not significant. DRPs were common. Potential drug interactions and adverse drug reactions dominated. Hospital-based medication review by a clinical pharmacologist was not associated with reduced rates of re-hospitalisation and/or death. The clinical relevancy of DRPs might be overestimated as a risk for re-hospitalisation or death. It is of great importance to clarify if and how drug-related problems can be prevented. In designing such studies, one should consider choosing inclusion criteria that accumulate risk.

Pharmaceutical Care Program for Patients With Uncontrolled Hypertension: Report of a Double-Blind Clinical Trial With Ambulatory Blood Pressure Monitoring

Pharmaceutical care programs may be an option to improve blood pressure (BP) control in patients with uncontrolled hypertension. The aim of this study was to evaluate the efficacy of pharmaceutical care programs in treating patients with resistant hypertension. In a double-blind randomized clinical trial, 71 patients with uncontrolled BP were enrolled in a pharmaceutical care program or in a control group and underwent a series of cognitive tests. The primary outcome was change in ambulatory BP (ABP) between the baseline evaluation and the final visit 6 months later. The secondary outcomes were the frequency of drug-related problems and adherence as determined by plasma levels of hydrochlorothiazide. The delta-values between the intervention and control groups for ABP in the different daily periods, with the corresponding 95% confidence limits, adjusted for age and baseline BP were: 3 (-1 to 5), 2 (-2 to 4), and 5 (-1 to 6) mm Hg for 24 h, daily and nightly systolic BP, respectively. The corresponding values for diastolic BP were 1 (-1 to 3), 0 (-2 to 2), and 3 (-1 to 4) mm Hg, respectively. Hydrochlorothiazide was detected in the plasma in 21 of 27 patients in the intervention group that attended to all appointments and 24 of 30 patients in the control group (P = .904). The pharmaceutical care program tested in this trial was feasible and showed a trend for better BP control in patients with uncontrolled hypertension.

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.