High Risk For Drug-related Problems Research Articles

Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital

BackgroundDialysis patients are at high risk for drug-related problems (DRPs), which have significant consequences for their morbidity, mortality, and quality of life. Improved clinical outcomes can be achieved by preventing, identifying, and resolving these problems.MethodsThis is a retrospective observational study. In this study, the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) was validated for use in Turkish. Validation consisted of three stages: translation back-translation with expert panel evaluation, reliability analysis using the test-retest method, and conceptual validity with both Pharmaceutical Care Network Europe (PCNE) and PAIR used to determine DRPs prevalence.ResultsIn total, 104 patients (mean ± SD age, 54.1 ± 15.8 years; 53.8% male) were included in the study. An expert panel evaluated the items in the criterion based on their intelligibility, service of purpose, differentiation, and cultural suitability during the translation stage. Content validity index (CVI) score was found to be 0.95. The reliability analysis was performed by applying the test-retest method and calculating correlation coefficient on 30 randomly selected patients one month later. Correlation coefficient (p) was found to be 0.8. To evaluate conceptual validity, 104 patients’ pharmacotherapy plans were assessed using both the PAIR and PCNE criteria. The prevalence of DRPs according to PAIR criteria (100.0%) and PCNE (73.1%) were statistically significantly different (p < 0.001).ConclusionsAs a result, PAIR criteria can identify clinically relevant DRPs in patients with CKD and is a new, validated tool to be used in Turkey, but may not be adequate for patients receiving dialysis. Therefore, it needs to be reviewed and updated for dialysis patients.

An observational study to determine the category and causes of the drug-related problems among geriatric inpatients

Background: Geriatric patients are at a higher risk of drug-related problems (DRPs) because of age-related chronic diseases leading to the use of numerous therapeutic regimens, and pharmacokinetic and pharmacodynamic changes. DRPs are associated with reduced quality of life, increased hospital admissions, prolonged hospital stays, and increased health-care costs. Aims and Objectives: This study aimed at identifying the category and causes of DRPs so that better strategies can be framed, thereby improving the quality of health care. Materials and Methods: The observational study was conducted among geriatric inpatients in a tertiary care hospital. The DRPs were identified using national and international standard guidelines. The Pharmaceutical Care Network of Europe (PCNE) classification version 9.01 was used to determine the category and causes of DRPs in the patients. Results: Seventy patients were enrolled in the study. A total of 102 DRPs were detected among these patients. The mean number of DRPs per patient was 1.45. According to the PCNE classification, 36 DRPs were related to treatment effectiveness, 27 were related to treatment safety, 25 were unnecessary drug treatments and 14 were related to cost effectiveness of the treatment. One hundred and fifty-one causes of DRPs were identified. The most commonly involved class of drugs in DRPs was antimicrobials. Conclusion: The number of DRPs noted in the present study was lower than those in the other studies. Majority of DRPs were treatment effectiveness-associated and caused due to errors in drug selection and use.

Drug-related problems in hospitalized patients with chronic kidney diseases and clinical pharmacist interventions

BackgroundPatients with chronic kidney disease (CKD) are at high risk of drug-related problems (DRPs) because of extensive comorbidities and pharmacokinetic changes. This study aimed to identify DRPs and possible contributing factors in hospitalized patients with CKD, and evaluate the efficacy of the clinical pharmacist services in detection and intervention of DRPs in a large general hospital in Zhejiang Province, eastern China.MethodsWith the approval of the Ethics Committee, patients with CKD admitted to the nephrology ward from January to December 2020 were enrolled in this prospective study. The clinical pharmacist identified and intervened the DRPs during hospitalization. The DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) DRP classification system, and all data were statistically analyzed using Statistical Package for Social Science (SPSS) version 26.0.ResultsA total of 914 patients with CKD were included, with 463 DRPs observed among 420 (45.95%) participants; the average DRP per patient was 0.51 (standard deviation [SD], 0.60) before pharmacist intervention. Treatment safety accounted for the highest proportion of problems (43.84%), followed by treatment efficacy, accounting for 43.20%. Drug selection was the most common cause of DRPs (60.26%), and antibiotics and cardiovascular agents were the most common drugs associated with DRPs (32.84% and 28.66%, respectively). A total of 85.53% of pharmaceutical intervention recommendations were followed, and 84.23% of DRPs were completely resolved after intervention by the clinical pharmacist. The proportion of patients who experienced DRPs decreased to 7.77%, with an average of 0.08 (SD 0.28) DRPs during hospitalization after pharmacist’s intervention. Significant contributing factors for DRPs were CKD stage 4, number of comorbid diseases, number of prescribed medications, and hospitalization days in both the univariate and multivariate logistic regression models.ConclusionDRPs are common among hospitalized patients with CKD in China. CKD stage 4, the number of comorbidities, use of multiple prescription drugs, and extended length of hospital stay are contributing factors for DRPs. Even only one clinical nephrology pharmacist in the nephrology ward, clinical pharmacist can play an important role in facilitating the identification of DRPs in patients with CKD and assisting physicians resolve DRPs in this single center study in China.

Scoring tool to identify patients at increased risk for drug-related problems: results of a point prevalence study at hospital admission

Drug therapy is a high-risk process and requires special attention, especially at sectoral borders. Pharmaceutical services such as medication review are appropriate measures to identify drug-related problems and thus improve the safety of drug therapy. Risk-scoring tools have been described in the literature as helpful for prioritizing medication reviews for patients at high risk for drug-related problems. In a multi-centre point prevalence study, we identified patients at increased risk for medication-related problems at hospital admission using the medication risk tool. In addition, the current level of implementation of pharmacy services was surveyed. A total of 11 (58%; 11/19) hospital pharmacies in Saxony participated in the point prevalence survey. The scoring tool identified 32% (279/875) of patients at increased risk for medication-related problems (Meris score >12 group) at admission. Thereby, the number of drugs in the Meris score >12 group was 10.6 (average; standard deviation 3.5; n=279), while in the Meris score ≤12 group it was only five drugs per patient (average 4.6; standard deviation 2.8; n=596). The age of patients in the Meris score >12 group averaged 75.9 ± 11 years, while the age of patients in the Meris score ≤12 group averaged 60.6 ± 17.9 years. Prioritization with the help of a risk-scoring tool is essential as pharmacy services in Saxon hospitals still need to be regularly established and in order to identify patients with an increased risk for drug-related problems at an early stage.

Rationalizing prescription via deprescribing in oncology practice.

To provide an integrated approach for deprescribing practice in oncology setting. The data on deprescribing in oncology settings has been retrieved from the PubMed, Scopus and Google Scholar. We used "deprescribing," "potentially inappropriate medication" and "cancer" as a keyword for the conducting general search. The articles relevant to guidelines or tools used to deprescribe in cancer care were included. The nature of cancer, its treatment strategies, adverse effects of therapy and multimorbidity impact negatively on quality of life (QoL). Further, they invite polypharmacy which puts the patient at higher risk of drug-related problems like drug interactions, adverse drug reactions and addition of potentially improper medications, etc. In older adults with cancer, the incidence of potentially inappropriate medications (PIMs) was between 41% and 52%. Over the decades, multiple strategies have been developed to assess the appropriateness of therapy. One such approach is deprescribing. OncPal and oncoSTRIP (Systematic Tool to Reduce Inappropriate Prescribing) are the cancer specific guidelines whereas BEERs criteria, Screening Tool to Alert to Right Treatment/Screening Tool of Older Person's Prescriptions criteria (START/STOPP criteria), medication appropriateness index (MAI) are the cancer nonspecific tools to identify PIM among cancer patients. Here, we provided an integrative approach and algorithm for deprescribing in oncology setting which includes patient and caregiver goals, life expectancy (LE), review of medications, determining medication appropriateness, assessment of time to benefit (TTB), symptomatic and asymptomatic care, identifying medications to cease, implementation of the plan, monitoring and reviewing. Deprescribing in oncology setting is a novel and effective patient-centric approach to counteract the use of PIM, which helps to mitigate polypharmacy, drug-drug interactions, and adverse effects.

Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer.

Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.

Impact of pharmaceutical care integrated at a psychosocial intervention to reduce caregiver's burden in Alzheimer's disease or related dementias: Negative results at 18 months and difficulties to conduct PHARMAID RCT

BackgroundPsychosocial interventions for caregivers of patients with Alzheimer disease and relative dementias (ADRD) reported a caregiver burden improvement. Multicomponent intervention integrating pharmaceutical care has not yet been evaluated while ADRD patients and their caregivers are exposed to high risk of drug-related problems. The PHARMAID study aimed to assess the impact of personalized pharmaceutical care integrated to a psychosocial program on the burden of ADRD caregivers at 18 months. MethodsThe PHARMAID RCT was conducted between September 2016 and June 2020 [ClinicalTrials.gov: NCT02802371]. PHARMAID study planned to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria were: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups compared a control group with two interventional groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome was the caregiver burden assessed by the Zarit Burden Index (ZBI, score range 0–88) at 18 months. ResultsOverall, 77 dyads were included (32% of the expected sample size). At 18 months, the mean ZBI scores were 36.7 ± 16.8 in the control group, 30.3 ± 16.3 for the group with psychosocial intervention, and 28.8 ± 14.1 in group with integrated pharmaceutical care at psychosocial intervention. No significant difference was demonstrated between the three groups (p = 0.326). ConclusionsThe findings suggest that PHARMAID program had no significant impact on caregiver burden at 18 months. Several limitations have been highlighted and discussed by the authors in order to formulate recommendations for further research.

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Abstracts 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”

Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting.

PurposeGeriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission.Patients and MethodsThe study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system.ResultsA total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians.ConclusionImproving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.

Effect of Pharmacist-Led Interventions on Physicians' Prescribing for Pediatric Outpatients.

Background: Children are at high risk of drug-related problems, increased risk of treatment failures, and high treatment costs. We aimed to evaluate the effect of pharmacist-led interventions on physicians’ prescribing for pediatric outpatients. Methods: A prospective study with pre- and post-intervention measurement assessment was conducted to collect pediatric outpatients’ prescriptions during the pre-intervention period (January 2020) and post-intervention (August 2020) at a children’s hospital in Vietnam. Drug-related problems were identified and categorized according to Pharmaceutical Care Network Europe (PCNE), version 9.1. The intervention program was developed based on the results of pre-intervention observations. After the intervention, prescriptions were evaluated. Statistical tests were used to compare the proportions of drug-related problems before and after the intervention and to identify factors related to drug-related problems. Results: There were 2788 out of 4218 (66.1%) prescriptions with at least one drug-related problem before the intervention. Of these drug-related problems, the most common was inappropriate timing of administration and incorrect dosage (36.1% and 35.6%, respectively). After the intervention, the percentage of prescriptions with at least one drug-related problem was 45.5% (p < 0.001). Most of the drug-related problem types decreased significantly (p < 0.05). The binary logistic regression analysis results showed that in addition to pharmacists’ intervention, patients’ gender, primary disease, comorbidity status, and the total number of drugs prescribed were also factors related to drug-related problems. Conclusions: Drug-related problems in pediatric outpatients were quite common. Pharmacists’ intervention helped to improve the prevalence and types of drug-related problems.

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.

Experimental Biology 2021 Meeting Abstracts.

According to WHO's definition, self‐medication is the use of drugs to treat self‐diagnosed disorders or symptoms. There is a high risk of self‐medication on the general population, mainly in South America. This phenomenon has been increasing with the SARS‐CoV‐2 outbreak, generating concerns, and anxieties in people, especially during the period of confinement. The present study used an online survey to determine the standard self‐medication practices, risk, and medication‐severity‐index of the Ecuadorian confinement population. This study is a quantitative descriptive analysis survey designed by pharmacists and medical professionals for the self‐medication during the confinement. A total of 400 Ecuadorian adults were recruited, and 380 adults accepted the digital informed consent, regardless of whether or not they had had symptoms of COVID19 during the quarantine. The survey platform used was Google Forms, and the digital social networks (WhatsApp, Facebook) were its broadcast medium. The inclusion criteria were adults who respect the confinement conditions. We excluded health professionals or who were already taking long‐term medication. The data were analyzed by R, and the Hazard‐Risk‐Assessment‐Score (HRAS) used the analysis of clinically relevant questions. There is a high risk of drug‐related problems, despite the high level of education of the surveyed population (63.1% third level and 26.72% 4th level). The 55% of the surveyed Ecuadorian population had an extreme risk of self‐medication (HRAS25 points), 35% prefer a drug therapy recommendation of TV, Social networks, and influencer, instead of Health professional (HRAS 20 points, moderate risk), and 39% ends up their medication before recommendations of a health professional (doctor or pharmaceutical), meaning in a moderate risk of self‐medication (HRAS 12 points). There is a high risk of the Ecuadorian population to self‐medication regardless of the level of education acquired. Even though the majority of the people answered requesting a prescription for the acquisition and consumption of drugs, they presented drug‐related problems.

The effectiveness of an independent anti-neoplastic medication therapy management system in ambulatory cancer patients.

BackgroundCancer has always been a serious health threat for human. Patients with cancer are at high risk of drug-related problems (DRPs) due to multi-morbidity associated polypharmacy. However, data is lacking in identifying and addressing potential DRPs in cancer patients in China. This study aims to investigate the prevalence of DRPs and evaluate the effectiveness of an independent anti-neoplastic medication therapy management (MTM) system in ambulatory cancer patients.MethodsThis is a retrospective study. An independent anti-neoplastic MTM system in Shanghai Jiao Tong University affiliated sixth People's Hospital was established in 2018 with the collaboration of oncologists, clinical pharmacists and software engineers. The system contains an independent clinic of pharmacy and MTM software. The software consisted of six modules to help clinical pharmacists serve the tumor patients. The six modules include medication therapy review, intervention plan, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up.ResultsA total of 173 eligible tumor patients visited the anti-neoplastic pharmaceutical clinic and were recorded in the independent anti-neoplastic MTM system from Jun 2018 to May 2019. The average clinic visits were 2.4 times of the study participants. Two thirds patients (117/173) had one or more identified DRPs in medication therapy review. Adverse drug reaction, potential drug interaction and non-adherence were the leading DRPs. 85.8% of DRPs could be resolved (cured or improved) in four weeks. Tumor patients showed medication adherence reached 84–100% after three or four times of follow-up and intervention.ConclusionsThe participation of clinical pharmacists in managing polypharmacy tumor patients, with the independent anti-neoplastic MTM system, facilitated the identifying and solving DRPs, especially improving medication adherence of patients, and thus enhancing the effectiveness, safety and rational use of medication.

Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions

Drug-related problems (DRP) cause preventable negative health outcomes, especially during hospital admissions. The aim of our study was to examine the prevalence and characteristics of DRP in regular clinical pharmacy, as well as to determine those factors associated with a higher risk of DRP in the hospital setting. We analyzed data from a standardized registry database of regular pharmacy practice (2015- 2016). DRP were classified according to the Pharmaceutical Care Network Europe v6.2 classification. Cross-sectional data were obtained from 1602 adults admitted to medical wards. Crude and adjusted binary logistic regressions were performed to identify associations between potential risk factors and DRP. Overall DRP prevalence was high across medical specialties (45,1%), in a population characterized by advanced age, polypharmacy and multimorbidity. Problems leading to DRP were mainly classified into two domains (effectiveness and adverse reactions), being drug and dose selection the most frequent causes. Interventions were accepted and DRP were totally or partially solved in 74.1% and 4.81% of cases, respectively. In the adjusted model polypharmacy, allergies, BMI > 25 kg/m2 and clearance < 30 mL/min were associated with a higher risk of DRP. The participation of clinical pharmacists into multidisciplinary teams promotes the detection and solution of DRP. Polypharmacy, obesity, renal impairment and allergy are associated with a higher risk of DRP during admission.

Impact of pharmacist interventions on drug-related problems in general surgery patients: a randomised controlled trial

ObjectivesThe inappropriate use of medications is harmful and is a common issue in hospitalised patients. Patients hospitalised in general surgery wards are usually at high risk for drug-related problems (DRPs)....

Pharmacy-led Medication Management Services in Long-term Care Facilities: Lessons from other Countries for Korea

The elderly usually have a high risk of drug-related problems by polypharmacy, therefore they are in need of drug management in long-term care facilities. This study aims to obtain the implications for developing a drug management system in long-term care facilities by pharmacists suitable for Korea by reviewing the drug management programs in long-term care facilities in countries that experienced population aging first. The United States, Canada, Australia, and Japan have enacted laws to optimize drug management in long-term care facilities according to the social demands of the aging population and operate specific programs based on those laws. Drug management programs in longterm care facilities operate in a variety of forms to suit the circumstances of each country. In long-term care facilities, pharmacists participate in the medication regimen review, in setting up drug related service frames and in developing relevant policies of the facilities. The results of the pharmacist s medication regimen review are not only provided to the doctor but also included in the medical record and kept for a while. Pharmacists emphasize cooperation with physicians and other health practitioners for proper drug management in long-term care facilities. In Korea, where the number of long-term care facilities is increasing along with the surge in the elderly population, it is necessary to develop a drug management system by pharmacists for safe drug use in long-term care facilities.

Prevalence and risk factors of drug-related problems identified in pharmacy-based medication reviews

Background Medication safety is a major health concern, especially for older patients, in whom drug-related problems occur frequently as a consequence of polypharmacy and frailty, increasing the risk of adverse drug events. Objective To investigate the prevalence and types of drug-related problems in community pharmacies and to identify associated risk factors in order to adjust the focus of care. Setting 300 German community pharmacies in Saxony-Anhalt (Germany). Method In April 2015, community pharmacists conducted brown bag medication reviews for primary care patients, in which they identified and solved drug-related problems with patients or their physicians. Data from these reviews were analyzed, including frequency and nature of problems and their respective resolutions. Potentially inappropriate medications according to the PRISCUS list were identified by post hoc analysis. Risk factors for drug-related problems were determined using bivariate and multivariate logistic regression analysis. Main outcome measure Prevalence and risk factors of drug-related problems. Results 1090 medication reviews were conducted. On average, patients were 72.0 ± 9.1 years old and had 10.6 ± 3.7 medications, 62.0% (n = 676) presented a medication plan. Knowledge gaps about medications were detected in almost a third of patients (n = 345). Drug-related problems were identified in 84.2% (n = 918) of patients (in 3836 medications). Frequent problems concerned drug–drug-interactions (53.7%, n = 585) as well as drug use and adherence (46.7%, n = 509). Most problems (72.2%, n = 2769) were resolved between pharmacist and patient. Knowledge gaps and the number of drugs were independently associated with a higher risk of drug-related problems. For older patients, potentially inappropriate medications were a risk factor in bivariate, but not in multivariate analysis. Conclusion Pharmacists identified and resolved considerable rates of drug-related problems, suggesting that they are capable and well-positioned to conduct medication reviews. Knowledge gaps, the number of drugs, patient age and, in older patients, potentially inappropriate medications may indicate an increased risk for drug-related problems.

Drug-related Problems in Hypertensive Patients: A Cross-sectional Study from Indonesia.

Objective:The treatment of hypertension requires special attention because of comorbidities and polypharmacy. In a previous study, polypharmacy has been associated with a high risk of drug-related problems (DRPs). This study aimed to analyze DRPs in Indonesian hypertensive patients focusing on drug therapy effectiveness and adverse drug reactions.Methods:A cross-sectional study was conducted using medical records' data, prescriptions, and nursing records to observe DRPs that occurred in outpatients with hypertension from February to April 2019. A total of 114 outpatients aged ≥23 years with a primary diagnosis of primary hypertension were included in this study. DRPs were reviewed based on literature, recent guidelines, and drug interaction software. Classification DRPs were done using Indonesian-translated Pharmaceutical Care Network Europe V6.02. The data obtained were analyzed using univariate descriptive analysis.Findings:Of all participants, 65 (57%) outpatients were found to have DRPs related to treatment effectiveness (54 cases) and adverse drug reactions (36 cases). The primary cause of the problems was an inappropriate drug (94.14%) and dose selection (2.86%). Potential drug interactions were found high (62.14%) in the combination of an antihypertensive agent with other drugs among patients. Overprescribing drugs without clear indications, untreated indications, and subtherapeutic dosage were also reported in this study.Conclusion:A significant percentage of outpatients being treated for hypertension experienced DRPs. The role of clinical pharmacists and physicians in monitoring drug therapy needs to be prioritized to prevent and resolve DRPs in outpatients with hypertension.

Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy

BackgroundSuccessful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded.MethodsA clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model.ResultsA total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%).ConclusionsTo our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.

Drug-Associated Risk Tool: development and validation of a self-assessment questionnaire to screen for hospitalised patients at risk for drug-related problems

IntroductionIdentifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge.ObjectiveTo develop a self-assessment screening tool...