Frequent Drug-related Problems Research Articles

Reduced prevalence of drug-related problems in psychiatric inpatients after implementation of a pharmacist-supported computerized physician order entry system - a retrospective cohort study.

In 2021, a computerized physician order entry (CPOE) system with an integrated clinical decision support system (CDSS) was implemented at a tertiary care center for the treatment of mental health conditions in Lübeck, Germany. To date, no study has been reported on the types and prevalence of drug-related problems (DRPs) before and after CPOE implementation in a psychiatric inpatient setting. The aim of this retrospective before-and-after cohort study was to investigate whether the implementation of a CPOE system with CDSS accompanied by the introduction of regular medication plausibility checks by a pharmacist led to a decrease of DRPs during hospitalization and unsolved DRPs at discharge in psychiatric inpatients. Medication charts and electronic patient records of 54 patients before (cohort I) and 65 patients after (cohort II) CPOE implementation were reviewed retrospectively by a clinical pharmacist. All identified DRPs were collected and classified based on 'The PCNE Classification V9.1', the German database DokuPIK, and the 'NCC MERP Taxonomy of Medication Errors'. 325 DRPs were identified in 54 patients with a mean of 6 DRPs per patient and 151.9 DRPs per 1000 patient days in cohort I. In cohort II, 214 DRPs were identified in 65 patients with a mean of 3.3 DRPs per patient and 81.3 DRPs per 1000 patient days. The odds of having a DRP were significantly lower in cohort II (OR=0.545, 95% CI 0.412-0.721, p<0.001). The most frequent DRP in cohort I was an erroneous prescription (n=113, 34.8%), which was significantly reduced in cohort II (n=12, 5.6%, p<0.001). During the retrospective in-depth review, more DRPs were identified than during the daily plausibility analyses. At hospital discharge, patients had significantly less unsolved DRPs in cohort II than in cohort I. The implementation of a CPOE system with an integrated CDSS reduced the overall prevalence of DRPs, especially of prescription errors, and led to a smaller rate of unsolved DRPs in psychiatric inpatients at hospital discharge. Not all DRPs were found by plausibility analyses based on the medication charts. A more interactive and interdisciplinary patient-oriented approach might result in the resolution of more DRPs.

Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study.

Drug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients' poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables. A cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study. A total of 762 DRPs were identified via prescribing review process, the average number of DRP on each prescription was 1.54±1.07, while 412 DRPs were determined through patient interviewing. The most frequent DRPs were "ADR (Adverse Drug Reaction) occurring" (68.8%). The main causes were "patient is unable to understand instructions properly" or "patient is not properly instructed", "patient stores insulin inappropriately", "patient decides to use unnecessary drugs" and "patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason" which accounted for 65.0%, 41.4%, 38.2%, and 28.7%, respectively. From the prescribing review, the most observed DRPs were "Inappropriate drug according to guidelines/formulary" and "No or incomplete drug treatment in spite of existing indication", accounting for 45.0% and 42.9%, respectively. There was a significant association between age (OR 3.38, 95% CI: 1.01-11.30), duration of diabetes (OR 3.61, 95%CI: 1.11-11.74), presence of comorbidity (OR 5.31, 95%CI: 1.97-14.30), polypharmacy (OR: 2.95, 95%CI: 1.01-8.72) and DRPs. In patients, poor knowledge of antidiabetic agents was the main reason to lack adherence and occurring ADR (OR 2.73, 95%CI: 1.32-5.66, p = 0.007 and OR 2.49, 95%CI: 1.54-4.03, p = 0.001 respectively). DRPs occurred in the prescribing stage and relating to patient's behavior of drug administration was high. Clear identification of DRPs and the associated factors are essential for building the intervention process to improve effectiveness and safety in the treatment of type 2 diabetes mellitus patients.

Documentation of drug related problems and their management in community pharmacy: Data evolution over six years

BackgroundDocumentation of pharmacists’ activities, such as drug related problems (DRPs) management, is necessary to estimate fair remuneration but is rarely done in community pharmacies. ObjectiveTo document and evaluate the evolution of DRPs prevalence and management over six years. MethodsObservational study carried out since 2016 in a community pharmacy. Documentation was made yearly for 21 days (depending on seasons, holidays and medical internship rotations) using the ClinPhADoc tool. Pharmacists documented: medication, DRP type, intervention, implied partner and time for DRP management. A subanalysis was made depending on the medical rotation. ResultsA total of 171 437 prescriptions were received and 6 844 (4.0%) documented with 1 550 DRPs. Most frequent DRPs were procedural (n = 506, 32.6%), dosage/posology (n = 263, 17.0%) and drug-drug interaction (n = 153, 9.9%). Mean time dedicated to DRP management was 6.9 min, the longest time was for clinical DRPs (11.0 min, SD = 6.6). Most DRPs (n = 726, 44.6%) were managed by the pharmacist alone taking less working time than when involving other stakeholders (p < 0.01). Statistically significant differences were found in DRPs between the beginning and end of medical rotation (p < 0.05). ConclusionsDocumentation of DRP management allowed consistent results over the years. Patterns of DRPs can be used to develop inter-professional interventions to prevent DRPs.

Drug-related problems in hypertension and gestational diabetes mellitus: A hospital cohort.

To characterize the drug-related problems (DRPs) in high-risk pregnant women with hypertension and gestational diabetes mellitus according to frequency, type, cause, and factors associated with their occurrence in the hospital setting. This is an observational, longitudinal, prospective study that included 571 hospitalized pregnant women with hypertension and gestational diabetes mellitus using at least one medication. DRPs were classified according to the Classification for Drug-Related Problems (PCNE V9.00). In addition to descriptive statistics, a univariate and multivariate logistic regression model was employed to determine the factors associated with the DRPs. A total of 873 DRPs were identified. The most frequent DRPs were related to therapeutic ineffectiveness (72.2%) and occurrence of adverse events (27.0%) and the main drugs involved were insulins and methyldopa. These were followed in the first five days of treatment by: the ineffectiveness of insulin (24.6%), associated with underdosage (12.9%) or insufficient frequency of administration (9.5%) and methyldopa associated with the occurrence of adverse reactions (40.2%) in the first 48h. Lower maternal age (OR 0.966, 95% CI 0.938-0.995, p = 0.022), lower gestational age (OR 0.966, 95% CI 0.938-0.996, p = 0.026), report of drug hypersensitivity (OR 2.295, 95% CI 1.220-4.317, p = 0.010), longer treatment time (OR 1.237, 95% CI: 1.147-1.333, p = 0.001) and number of prescribed medications (OR 1.211, 95% CI: 0.240-5.476, p = 0.001) were risk factors for occurrence of DRPs. DRPs are frequent in pregnant women with hypertension and gestational diabetes mellitus, and they are mainly related to therapeutic ineffectiveness and the occurrence of adverse events.

Drug-related problems identified at a Japanese community pharmacy: a cross-sectional study

Abstract Objectives This study aimed to identify drug-related problems (DRPs) using data regarding the communication of pharmacists with prescribers over the phone at a community pharmacy. Furthermore, we elucidated the frequency of the sources of information for detecting each DRP and evaluated the decisions made by the prescribers for each DRP. Methods This cross-sectional study was conducted at a community pharmacy in Fukuoka Prefecture, Japan. We anonymously collected data obtained by pharmacists through contacting prescribers over the phone relating to any problems or doubts found in prescriptions between April 2016 and March 2019. We classified the data and identified DRPs. We elucidated the frequency of sources of information for detecting each DRP using descriptive analyses and evaluated prescribers’ decisions regarding each DRP via multivariate Poisson regression analyses. Key findings Of the 95 023 prescriptions, 5073 DRPs were identified (5073/95 023 = 5.34%). The most frequent DRP was inappropriate dosage and administration (1349/5073 = 26.59%), followed by non-adherence (1272/5073 = 25.07%) and incorrect prescription periods (889/5073 = 17.52%). Patient interviews were the most frequent sources of information for detecting following DRPs: non-adherence (1057/1272 = 83.10%), untreated indication (590/631 = 93.50%) and adverse drug reactions (80/107 = 74.77%). Most of the DRPs were resolved by making changes to the prescriptions (4571/5073 = 90.10%). Conclusions Inappropriate dosage and administration and non-adherence issues were the most frequent DRPs in a Japanese community pharmacy. Patient interviews were an important source of information for detecting DRPs. Further research is warranted to address the impact of DRPs on patient safety.

Drug-related problems among hospitalized hypertensive and heart failure patients and physician acceptance of pharmacists' interventions at a teaching hospital in Ghana.

BackgroundHypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug‐related problems (DRPs).AimTo determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients.MethodIt was a prospective cross‐sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis.ResultsA total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and “no” or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04–47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18–0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14–0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03–17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved).ConclusionDRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.

Drug-Related Problems and Factors Involved in the Imbalance of Oral Anticoagulants in Lebanese Patients: A Cross-Sectional Study

The goal of this study was to identify drug-related problems (DRPs) and the factors involved in the imbalance of new oral anticoagulants (NOACs) and vitamin K antagonists in a Lebanese adult population with cardiovascular diseases. An imbalance in the hemostatic systems between procoagulant and anticoagulant factors in circulating blood produces either hemorrhagic or thrombotic conditions. A prospective cross-sectional study was conducted during 5 months in a teaching hospital. All patients at least 18 years of age taking oral anticoagulants were included in the study. A standardized questionnaire was used, and information was obtained from the patients’ profiles and electronic medical records. DRPs were identified and categorized according to the Pharmaceutical Care Network Europe classification system. A total of 258 patients were included. The overall prevalence of DRPs was 87.2%; the highest prevalence was observed in patients taking acenocoumarol (96.0%), in contrast to 76.7% and 59.0% in patients taking dabigatran and rivaroxaban, respectively. Drug interaction was the most frequent DRP (83.3%), followed by inappropriate monitoring (42.6%) and excessive dose (26.7%). Having renal disease, and taking proton-pump inhibitors or nonsteroidal anti-inflammatory drugs were among the factors affecting the international normalized ratio (INR) range (adjusted odds ratio [ORa] = 2.513, 95% confidence interval [CI] 1.238, 5.101; ORa = 2.487, 95% CI 1.139, 5.430 and ORa = 2.114, 95% CI 1.043, 4.286, respectively), whereas smoking and renal disease significantly affected activated partial thromboplastin time (aPTT) (ORa = 8.325, 95% CI 1.577, 43.965 and ORa = 6.922, 95% CI 1.471, 32.570, respectively). Patients taking NOACs had greater aPTT control and fewer DRPs, with a wide therapeutic index enabling administration of fixed doses.

Community pharmacists' routine provision of drug-related problem-reduction services.

ObjectivesThe present study aimed to assess the degree of the provision of services for drug-related problems (DRPs) and the factors affecting provision within the community pharmacy setting in Irbid, a large city in Northern Jordan.MethodsA cross-sectional survey was developed and administered to community pharmacists in Irbid, Jordan during the period from January to May 2017. The survey is composed of background and practice characteristics, services provided routinely by the community pharmacists to address DRPs, and barriers and facilitators for DRP-reduction services. A summated score quantifying the degree of DRP-reduction service provision was calculated, which included overall scores and scores for the different scales and domains. Statistical analysis included descriptive statistics and a multivariate linear regression model for factors associated with the high provision of DRP-reduction service.ResultsTwo hundred community pharmacists out of 210 pharmacists approached completed the surveys yielding a response rate of 95.2%. The most frequent DRPs encountered within the routine practice in the community pharmacy were economic aspects (76.0%). The mean total score relating to different DRP-reduction services was 32.9 (58.8%) out of 56 as the maximum possible score. It was estimated that 28.2% of the responding pharmacists provided the service overall (scored more than 50% of the scale). For the assessment, intervention, and referral dimensions, similar percentages of providers of the services were achieved: 59.7%, 61.9%, and 49.0%, respectively. Lower rates of providers were achieved on the documentation scale (12.9%). The lack of recognition of the pharmacist role by physicians was the most commonly reported barrier to effective DRP-reduction services among community pharmacists (78.9%). The ability to receive external guidance was indicated by the majority of surveyed pharmacists (94.5%) as a potential facilitator to DRP-reduction services in this study. Predictors associated with high total scores were the presence of medical records for the patients in the pharmacy, patients contact the pharmacy using email, a high satisfaction in professional relationships with physicians, and pharmacists’ age.ConclusionEven though community pharmacists in this study have been shown to deliver certain activities to address DRPs to a high degree, the overall rate of DRPs services was suboptimal. Community pharmacists reported several barriers that should be taken into consideration to facilitate the role of community pharmacists in providing adequate DRP reduction services to patients.

Influence of drug-related problems on length of hospital stay of women with a history of preeclampsia: A multicenter study.

Approximately 5-7 % of pregnant women have hypertension during pregnancy, requiring antihypertensive drug treatment. There have been a lack of studies evaluating how drug-related problems (DRPs) affect morbidity or mortality in the postpartum period among women with a history of preeclampsia. To determine the influence of drug-related problems on length of hospital stay of postpartum women with a history of preeclampsia. This cross-sectional study included postpartum women diagnosed with preeclampsia, from June to November 2016, in two teaching maternity hospitals in Brazil. The outcomes assessed were, length of hospital stay of postpartum women. The DRPs were classified through the Pharmaceutical Care Network Europe Foundation (PCNE) v 8.01. 600 women were included, and 354 (59%) were exposed to at least one DRP. The most frequent DRPs were no administration of the prescribed medication, lack of prescription of a medication, although the indication was clear, and ineffectiveness (unknown reason). In patients exposed to DRP, the average length of hospital stay after labour was 5.4 (S.D. 3.6) days versus 4.4 (S.D. 3.3) days in patients non-exposed to DRP (p=0.0001). The period (in days) to achieve blood pressure control after labour was 4.5 (S.D. 3.5) 3.5 (S.D. 3.2), respectively (p=0.0001). There were no deaths during the study. Drug-related problems significantly increased the length of hospital stay in postpartum women with a history of preeclampsia.

Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital.

Introduction:Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists’ interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units.Methods:A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.’s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes.Results:A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists’ interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients.Conclusion:The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.

Identification and solution of drug-related problems in the neurology unit of a tertiary hospital in China

BackgroundThe prevalence and characteristics of drug-related problems (DRPs) and factors associated with the occurrence of DRPs in the neurology unit in China remain unknown. This study aimed to determine the prevalence, characteristics and severity ratings of DRPs and identify factors associated with the occurrence of DRPs in the neurology unit of a tertiary care and academic teaching hospital in China.MethodsA retrospective study of DRPs and pharmacists’ interventions for neurology patients was performed during a non-consecutive 24-month study period. Patient demographics and clinical characteristics, and pharmacist’s intervention records were collected. The characteristics and severity ratings of DRPs were categorized using the Pharmaceutical Care Network Europe (PCNE) DRP classification tool V9.00 and the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classification respectively.ResultsA total of 242 DRPs were detected for 974 admitted patients, an average of 0.25 DRPs per patient. Treatment safety was the major type of DRPs (106;43.8%) followed by treatment effectiveness (78;32.2%). The primary causes of DRPs were drug selection (124;44.1%) and dose selection (92;32.7%). Clinical pharmacists provided 525 interventions, and most interventions occurred at the prescriber level (241;45.9%). A total of 91.4% of these interventions were accepted, contributing to solving 93.0% of the identified problems. The majority of DRPs (210;86.8%) were rated at severity categories B to D (causing no patient harm). Multiple logistic regression showed that creatinine clearance, number of medications used, nasogastric feeding, diabetes, and infectious diseases were associated with more frequent DRPs (p < 0.05).ConclusionsDRPs are relatively common in the neurology unit in China, with primary causes of drug and dose selection, and clinical pharmacists can effectively reduce and prevent DRPs to optimize medication therapy.

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

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

Assessing the impact of clinical pharmacy services on the healthcare outcomes of patients attending an outpatient haemodialysis unit in a rural hospital in Egypt: a quasi-experimental study

Abstract Objectives This study aimed to investigate the impact of newly introduced clinical pharmacy services on the health care of chronic haemodialysis patients attending an outpatient haemodialysis unit in a rural hospital with limited resources in Alexandria, Egypt. Methods A quasi-experimental pre-/post-test study was conducted from November 2016 till June 2018. Clinical pharmacists collected relevant information using a pre-specified form. Patients’ data were reviewed for drug-related problems (DRPs), which were documented using the Pharmaceutical Care Network Europe (PCNE) classification system, version 8.02 and resolved by the clinical pharmacists. Measured values of calcium, phosphorus and haemoglobin were compared with target levels set by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Proportions of patients achieving therapeutic values of each parameter were compared before and after implementing the program using the McNemar test. We also reported the analysis of DRPs identified and addressed by the clinical pharmacy team. Key findings A total of 685 DRPs were identified during the follow-up period. Improper dose and inappropriate drug selection were the most common DRPs (45.8% and 18.9%, respectively). There was a statistically significant increase in the proportion of patients achieving target corrected calcium levels (30% pre-intervention versus 69.6% post-intervention, P = 0.001) and haemoglobin levels (9.1% pre-intervention versus 31.9% post-intervention, P = 0.003), but not in phosphorus levels (18.6% pre-intervention versus 22% post-intervention, P = 0.7). Conclusions Clinical pharmacists were able to resolve frequent DRPs and improve some markers of health care in haemodialysis patients.

Le bilan partagé de médication: intérêt de la mise en place d’un nouveau service pharmaceutique dans la detection de problemes lies aux therapeutiques

Using clinical medication reviews, analyze the most pharmaceuticals intervention generating treatments and the problems associated. Analysis of activity reports made by 6th year pharmaceutical students from the University of Bordeaux, class of 2017-2018. 76% of clinical medication review have detected at least one drug related problem in the population of this study. Drug classes that most frequently lead to pharmaceutical interventions are nervous system drugs, alimentary tract and metabolisma drugs and cardiovascular system drugs. The most frequent drug related problems are an unjustified prescription, a contraindication or a non-compliance with the standards of care and posology issues. The most at risk and pharmaceutical intervention generating drugs in this study are the same as described in the international literature. This shows that more precautions must be taken for their use in the elderly. Furthermore, this new pharmaceutical service is an efficient way to detect them.

Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients.

Background The use of highly toxic drugs in cancer treatment and supportive care medications exposes patients to an increased number of drug-related problems (DRPs). Clinical pharmacists contribute to the optimal use of medications by intervening in identified drug-related problems. Objective To evaluate the relevance of a comprehensive medication management service in oncology patients. Setting Marmara University Teaching and Research Hospital Medical Oncology Ward, Istanbul, Turkey. Methods This prospective study was carried out between December 2015 and April 2016 with adult patients with confirmed malignancy. Comprehensive medication management was performed by the clinical pharmacist throughout the patient's hospital stay. The medication-related data as well as data regarding demographic and general health status of the patients were reviewed for the presence of drug-related problems. The identified problems, interventions and acceptance rate by physicians were recorded with the help of the Pharmaceutical Care Network Europe V6.0 (PCNE) classification. Main outcome measures Number and causes of drug-related problems, nature and acceptance rate of clinical pharmacist interventions and rate of problems solved. Results The study included 137 patients. The mean (SD) age of the patients was 58 (14.6) years. A total of 481 drug-related problems were recorded. The most frequent drug-related problems were 'adverse drug events [including drug interactions]' (n = 376), 'untreated indications' (n = 59) and 'unnecessary drug treatment' (n = 25). Inappropriate combination of drugs was the cause of 73.2% of the total problems. Interventions were made to stop administration of a suitable drug if the combination with another drug was contraindicated while prescribers were mostly informed about major drug interactions. The prescribers approved 93% of the total intervention proposals. The majority (90.9%) of the identified problems were totally solved. Conclusion Integration of clinical pharmacy services through a comprehensive medication management program in oncology will help to reduce the number of drug-related problems.

Tamoxifen treatment adherence assessment by women with breast cancer

Justification and objectives: oral antineoplastic therapy has advantages compared to other&#x0D; therapies for the treatment of cancer, as it is administered at home, in a simple and fast way.&#x0D; However, this therapy increases patients’ responsibility for their treatment, and compliance is&#x0D; critical to its effectiveness. Few studies are evident regarding pharmacotherapeutic follow-up&#x0D; in oral antineoplastic therapy. In this context, this study seeks to assess adherence to tamoxifen&#x0D; treatment in women with breast cancer, before and after pharmacotherapeutic follow-up.&#x0D; Methods: this is a randomized, quantitative clinical study. Data collection was carried out for&#x0D; six months. Random randomization was divided into a control group and a follow-up group,&#x0D; with the follow-up subdivided into before and after follow-up. The follow-up group received&#x0D; individual pharmaceutical interventions monthly. Adherence was assessed by The Brief&#x0D; Medication Questionnaire, Brazilian version and drug-related problems as to necessity,&#x0D; effectiveness, and safety. Results: after pharmaceutical follow-p, a difference was observed&#x0D; between the follow-up group and the control group regarding physical activity (p=0.043),&#x0D; treatment adherence (p=0.006), reduction of side effects (p=0.003) and associated diseases&#x0D; (p=0.002). The most frequent drug-related problems were safety and adherence, for which 54&#x0D; pharmaceutical interventions were performed. The side effects described by patients mainly&#x0D; affected the genital system and gastrointestinal tract. Conclusion: it was evident that&#x0D; pharmacotherapeutic follow-up effectively contributed to adherence to treatment with&#x0D; tamoxifen and the pharmaceutical interventions performed contributed to prevention and&#x0D; reduction of drug-related problems.

Analysis and management of drug related problems on a nephrology ward from a pharmacist's point of view.

The main goal of the study was to determine the incidence and the character of drug related problems (DRPs) identified in chronic kidney disease patients by the clinical pharmacist at the nephrology department. As secondary objective, the aim was to identify the frequency and character of DRPs of selected high risk drugs in medication reviews. The clinical pharmacist reviewed patients' medication records and made drug therapy-related recommendations to physicians. The clinical pharmacists' interventions were categorized using an adaptation of the Pharmaceutical Care Network Europe. During the study period (January 2016 - June 2018) the clinical pharmacist performed 1192 interventions in 1870 adult patients admitted to the Nephrology Department. The most frequent DRP was untreated indication 324 (27.18%) of all interventions, and incorrect dose 248 (20.81%). Anti-infectives were identified as the drug category with the highest frequency of interventions. Almost 93% of all interventions were accepted by the attending physicians. Still within the second objectives, underdosing was observed as the most frequent problem for renally excreted drugs. It was found that an incorrect dose is a very frequent issue at the nephrology department. Surprisingly, the main problem was underdosing. In the category of renally excreted drugs, underdosing was observed in antithrombotics and antivirals. The above- mentioned results prove the need of a clinical pharmacist, preferably in sense of maximizing of the treatment effect and improving the care of patients.

Pharmaceutical care in a school pharmacy: from consultation to resolution of drug-related problems

This study aimed to provide pharmaceutical care for the general community served by Pharmacy students from the Pharmacy School of the State University of Maringá [Universidade Estadual do Maringá] (UEM). Pharmacotherapeutic follow-up was performed with the identification, classification and resolution of drug-related problems (DRPs) through pharmaceutical consultations. A descriptive analysis was conducted. A total of 59 patients were interviewed; they were mostly women (75%) with average age of 63 years, and each of them was taking 8 medicines on average. The most frequently mentioned drugs were classified according to the Anatomical Therapeutic Chemical Code and related to cardiovascular system (28%), alimentary tract and metabolism (23%), and nervous system (20%). An average of 1.49 DRP per patient was detected (88), and treatment non-compliance was the most frequent DRPs found (45%). In view of this, 63 pharmaceutical interventions were carried out, with most of them (52%) being related to patient education on the treatment; approximately 20% of the patients were referred to another health professional. Information supplied by this study shows the relevant role of pharmacists face the lack of pharmacotherapeutic follow-up of polymedicated patients.

Clinical Outcomes of Drug-related Problems in Saudi Arabia: Patients’ and Healthcare Providers’ Perspective

<p style="text-align: justify;"><strong>Purpose:</strong> To explore the patients and healthcare providers&rsquo; attitudes and perceptions on clinical outcomes drug-related problems in Saudi Arabia. <strong>Methods:</strong> It is a 4-months cross-sectional survey of drug-related problem information in Saudi Arabia. The study consisted of two-part a demographic data. The second part contained the questions about the frequent occurrence of drug-related problems, the type of medication-induced those problems, and the drug-related problem clinical consequences and outcomes. American Society of Health- System Pharmacist definitions of drug-related problems used. The 5-point Likert response scale system used. The survey distributed through social media. The questionnaire made of an electronic format, and it analyzed through survey monkey system. <strong>Results:</strong> The total responders were two hundred and one; the Saudi nationality was 188 (93.5%), and non-Saudi was 13 (6.5%) patient. The gender distribution was female 180 (89.6%), and the male was 21 (10.4%). The majority of them in age (18-44) 88% and located in Riyadh region 84 (41.8%) and Asir region 59 (29.4%). Of those 44 (22.1 %) were healthcare providers. The responders showed a high percentage of drug-related problem consequences and outcomes; drug-related problem lead to pharmacy visit was 59 (29.5%), additional tests were 47 (24.35%), ambulatory care clinic visit was 76 (38.4%), and an emergency visit was 43 (21.4%). The hospital admission was 46 (23.1%), general surgery 24 (11.9%), critical care admission was 24 (12.1%), and drug-induced death was 48 (24.12%). The most frequent drug-related problems occurred with the patient last year at least once; it was drug noncompliance 142 (71.4%), indications without medication 100 (50%), and adverse medication events 80 (40%). The most type of medicines induced the problems were Antibiotics, the drugs for pain, and dermatology drugs. <strong>Conclusion:</strong> Clinical outcome of drug-related problems occurred was potential. Clinical pharmacy services with emphasis to a drug-related program of antibiotics, painkiller dermatology medications are necessary. Moreover, to patient counseling program in health institutions and public awareness of medications is required in Saudi Arabia. <p style="text-align: justify;"><strong>Key words:</strong> Clinical outcomes, Drug-related problems, Patients, Healthcare providers, Perspective, Saudi Arabia.

Patients and Healthcare Providers’ Attitudes and Perceptions of Drug-related Problems in Saudi Arabia

Purpose: To explore the patients and healthcare providers’ attitudes and perceptions of drug-related problems in Saudi Arabia. Methods: It is a 4-months cross-sectional survey of drug-related problem information in Saudi Arabia. The study consisted of two-part a demographic data, and second part contained the questions about the knowledge of drug-related problems, the frequent occurrence, the type of medication-induced those problems, and the resources information used about the drug-related problem. American Society of Health- System Pharmacist definitions of drug-related problems used. The 5-point Likert response scale system used. The survey distributed through social media. The questionnaire made of an electronic format, and it analyzed through survey monkey system. Results: The total responders were two hundred and one; the Saudi nationality was 188 (93.5%), and non-Saudi was 13 (6.5%) patient. The gender distribution was female 180 (89.6%), and the male was 21 (10.4%). The majority of them in age (18-44) 88% and located in Riyadh region 84 (41.8%) and Asir region 59 (29.4%). Of those 44 (22.1 %) were healthcare providers. The majority of responders showed good knowledge about medication non-compliance 150 (75.76%), and medication without indication 147 (73.1%), while an adequate revealed information of adverse drug reaction 128 (64%), and an indication without medication 124 (62%). The imperfect information found about drug interaction 75 (37.5%) and drug poisoning 89 (44.5%). The most frequent drug-related problems occurred with the patient last year at least once; it was drug noncompliance 142 (71.4%), indications without medication 100 (50%), and adverse medication events 80 (40%). The most resources information on drug-related problems used were the internet, medicine leaflet, and healthcare practitioners. Conclusion: Drug-related problems occurred at a high rate in Saudi patients. The knowledge of drug-related problems is not adequate. It is very demanding and comprehensive public education about medication and urgent implementation of the patient medications counseling program in Saudi Arabia. Key words: Patients, Healthcare providers, Attitudes, Perceptions, Drug-related problems, Saudi Arabia.