Identification Of Drug-related Problems Research Articles

Evaluation of a novel clinical pharmacy tool in identifying and categorising drug-related problems in hospitalised patients: The MA2VER2ICK Tool Study

Abstract Introduction Literature searching has revealed a lack of high-quality research outlining the use of tools or checklists in hospitalised patients. Additionally, few tools identified relate directly to clinical pharmacy practice. The tools identified focus on specific disciplines (e.g. critical care) or specific tasks (e.g. handover). The MA2VER2ICK Tool is a novel clinical pharmacy tool which has recently undergone review and adaptation.[1] The tool is unique as it is comprehensive and applicable to all hospitalised patients, regardless of clinical discipline. The intended purpose of the tool is to assist clinical pharmacists in comprehensive pharmaceutical care planning. Aim Demonstrate the utility of the MA2VER2ICK tool in pharmaceutical care planning, by outlining the type and frequency of drug-related problems occurring in hospitalised patients. Methods A prospective, observational, cross-sectional study was conducted in a 560-bed acute university teaching hospital. Clinical pharmacists adopted the tool in their daily practice, in a mixed medical-surgical inpatient population, over four weeks. All drug-related problems identified were recorded and assigned to the applicable category within the tool, by the clinical pharmacist. Additionally, all drug-related problems were retrospectively assigned to applicable categories of the Pharmaceutical Care Network Europe Classification for Drug Related Problems Version 9.1,[2] for comparison, by two independent researchers. Results All identified drug-related problems identified were successfully categorised using the MA2VER2ICK Tool. In total, 753 drug-related problems were identified in 180 patients over four weeks, with 233 patient-pharmacist encounters occurring. The mean age of patients was 68.9±16 years, while 51.7% (93/180) were female and 48.3% (87/180) were male. The mean number of drug-related problems identified per patient was 4.2±3.6. The highest number of drug-related problems experienced by an individual was 20, while 17 patients experienced no drug-related problem. The majority of drug-related problems identified using the tool related to medication reconciliation (52.7%; 397/753), followed by prescription endorsement and administration (17.3%; 130/753) and pharmacotherapy optimisation (9.3%; 70/753). In comparison with the MA2VER2ICK Tool, the Pharmaceutical Care Network Europe classification system has a much larger range of categories for assigning drug-related problems. Despite this, a proportion of identified drug-related problems 1.6% (12/753) could not be categorised using this tool, while there were also several categories within the tool 43.2% (19/44) whereby no drug-related problems were assigned. Conclusion This study demonstrates that the MA2VER2ICK Tool is a robust clinical pharmacy tool, that is effective and practical in assisting clinical pharmacists with the identification of drug-related problems and thus is a useful guide to facilitate pharmaceutical care planning at the patient’s bedside. This is in comparison with the Pharmaceutical Care Network Europe classification system, which has less utility as a clinical pharmacy tool, but is better placed as a research instrument. Despite demonstrating the usefulness of the MA2VER2ICK Tool in identifying drug-related problems, the clinical significance of those identified was not assessed during this study. However, data collection occurred in real time, facilitating the identification of actual and potential problems, thus reducing the likelihood of underestimating the incidence rate.

Pediatric oncology services in Nepal: A special focus on pharmacy practice.

The role of clinical pharmacists or oncology pharmacists in pediatric oncology has been established as important in anticancer regimen review, dose calculation, recommendation, chemocounseling, identification of drug-related problems, its resolution, and, prevention and monitoring of adverse drug reactions within high-income countries. With several hospitals providing pediatric oncology services in Nepal, clinical pharmacist involvement in these hospitals is very poor. Upon reviewing the reputed organization and association focused on pediatric oncology pharmacy practice, it looks imperative for Nepal to initiate clinical pharmacy services which will further help in improving patient health outcomes. As such in this commentary, we try to accentuate the pediatric oncology services and pediatric pharmacy practice within Nepal and try to pinpoint the potential areas for clinical pharmacists to focus if they intend to provide services in pediatric oncology pharmacy practice.

Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Identification of Drug-Related Problems (DRPS) of drugs with special dosage forms in geriatric patients (study at the outpatient pharmacy unit, Airlangga University Hospital, Surabaya)

Developing and piloting a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice.

Healthcare is challenged by a rapidly growing group of patients with multi-morbidity and polypharmacy. Increasing activity and specialization puts pressure on healthcare sectors. Medication errors in cross-sectoral transition of patients are often seen. The aim of the study was to explore drug-related problems (DRPs) in the transition of patients between sectors and to develop and pilot-test a cross-sectoral hospital pharmacist intervention to overcome some of these problems. DRPs in cross-sectoral transitions were explored from four perspectives; the literature, the primary and secondary healthcare sector and the patients. An intervention was developed from the findings through co-creation between pharmacists, doctors and a nurse. The intervention was piloted and evaluated from data on the included patients and the activities performed. DRPs in transitions from general practice (GP) to hospital were caused by inadequate focus on updating the Shared Medication Record (SMR). For patients being discharged, DRPs were described with multiple facets; for example, missing information on medication changes, lacking patient involvement and problems with dose-dispensed medicine or electronic prescriptions. An intervention with a pharmacist in a shared employment between Hospital Pharmacy and GP was developed and piloted. The intervention included medication reconciliation and updating SMR for patients referred to hospital; and medication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital. The intervention identified and solved several DRPs; in this way, medication errors were avoided. Access to health records in both sectors was important in the identification and resolution of DRPs. DRPs in cross-sectoral transitions are multifaceted and the experiences depend on the point of view. The cross-sectoral hospital pharmacist intervention identified and solved several DRPs and medication errors were avoided. The intervention made sense to both healthcare sectors and patients. Shared employment and unique access to health records in both sectors showed to be of importance in the identification and resolution of DRPs. Development and pilot-test of a pharmacist intervention for patients in transition between hospital and general practice Background: Healthcare is challenged by a rapidly growing group of patients with multiple chronic diseases treated with several drugs at the same time. The aim of the study was to explore drug-related problems in the transition of patients between the hospital and patients' general practitioner and to develop and pilot-test a pharmacist intervention to overcome some of these problems.Methods: Drug-related problems in patient transitions were explored from the perspectives of the hospital, the general practitioner, the patients and the literature. An intervention was developed from the findings by pharmacists, doctors and a nurse. The intervention was pilot-tested and evaluated from the descriptions of the included patients and activities performed.Results: Drug-related problems in transitions from general practice to hospital were caused by inadequate focus on updating the Shared Medication Record.For patients being discharged, drug-related problems were related to for examplemissing information on medication changessparse involvement of the patient in their own treatmentproblems with medicine dispensed on a dose dispensing machine at the local pharmacy.An intervention with a pharmacist in a shared employment between Hospital Pharmacy and general practice was developed and piloted. The intervention includedtalking to the patient about their medication and updating the Shared Medication Record for patients referred to hospitalmedication review, overview of medication changes and follow-up telephone calls for patients discharged from hospital to general practice.The intervention identified and solved several drug-related problems. Access to health records in both the general practice and at the hospital was important in the identification of drug-related problems.Conclusions: Drug-related problems in cross-sectoral transitions are multifaceted. The pharmacist intervention identified and solved several drug-related problems. The intervention made sense to the general practitioner, hospital and patients. Shared employment and unique access to health records in both the general practice and at the hospital showed to be of importance in the identification of drug-related problems.

Drug-related Problems among Inpatients of General Medicine Department of a Tertiary Care Hospital in South India

Background: Identification of drug-related problems (DRPs) is a medication management service that can add value to individual patient care. Determination of DRPs daily is a promising approach for optimizing treatment. Objective: The objective of this study was to analyze the incidence of DRPs identified along with the risk factors that contribute to its development. Setting: This study was conducted in a tertiary care hospital in Central Kerala, India. Methods: A cross-sectional study was conducted among 300 newly admitted patients to the general medicine department. Patient medical records were reviewed in 3 stages – medication reconciliation, medication order review, and discharge summary review, and DRPs were categorized based on the Pharmaceutical Care Network Europe V9.1. Patient characteristics such as age, gender, polypharmacy, comorbidities, nonadherence, and type of illness were recorded. Results: Out of 300 patients, 78.7% had DRPs. The incidence of DRPs was found to be 0.26 cases/people-months. Although age >60 years, gender, polypharmacy, nonadherence, comorbidities, and chronic ailments were risk factors for DRPs, only polypharmacy and comorbidities could be proven statistically. Conclusion: DRPs are an emerging issue within the confines of the health-care system and should be scrutinized to avoid negative outcomes. A stage-wise analysis of patients who are at risk will ensure better patient care.

Identification of Drug-Related Problems and Investigation of Related Factors in Patients with COVID-19: An Observational Study

Identification of Drug-Related Problems and Investigation of Related Factors in Patients with COVID-19: An Observational Study

Utilization Review of Antibiotics in the Treatment of Urinary Tract Infection

Aim: To evaluate the rationality of pharmacotherapy of UTI and to identify drug related problems (DRPs) in the treatment of UTI. Methodology:, a prospective study was perfomed in Ayub Teaching Hospital Abbottabad Pakistan for a period of three months (December 2019 to March 2020) on 62 patients suffering from UTI. Data of patient disease and treatment was collected from patient medical chart record file and then pharmacotherapy was evaluated for accessing rationality and identification of DRP using standard book like British national formulary and standard treatment guidelines. Statistical analysis of the data was performed by using SPSS. Results: Result of this study showed that prevalence of UTI was more in female (67.74%) than males (32.25%). Patients belonging to the age group of 20-40 years were more prone to UTI. The most frequent problems were presence of drug interactions, dosage problems cases, overprescribing cases, therapeutic duplication cases and lack of cost effectiveness cases. After analyzing the use of antibiotics it was found that most widely used antibiotics in the treatment of UTI was ceftriaxone, followed by levofloxacin and ciprofloxacin. Culture Sensitivity test for appropriate selection of antibiotics was not perfomed in 80% of cases. Wrong dose of antibiotics was prescribed in 27.4% cases; therapeutic duplication of antibiotics was found in 6% of patient prescription and over usage of antibiotics was observed in 18% of cases. Conclusion: Irrational use of drugs especially antibiotics in the treatment of UTI can adversely affect desired therapeutic outcome, lead to therapy failure and emergence of resistance of antibiotics which is a major concern. Drugs for the treatment of UTI should be used rationally according to the need and standard prescribing protocol to improve patient therapeutic outcome and to decrease the adverse consequences of drug therapy. . Keywords: Urinary tract infection, drug related problems and antibiotic use

Management of epilepsy in Lebanon: Medication reviews and drug-related problems.

The goal of epilepsy treatment is to control seizures without drug related problems (DRPs). The evaluation of anti-seizure drugs (ASD) strategies and identification of DRPs are rarely studied. This study aimed primarily to evaluate the choice of ASD according to international guidelines and secondarily to identify and describe anti-seizure drug-related problems. A cross-sectional study was conducted during 1 year among Lebanese adults with epilepsy attending neurology clinics. The choice of ASD was compared to National Institute for Health and Care Excellence guidelines. Drug-drug interactions were evaluated by the Lexicomp database, and the DRP classification was performed using the Pharmaceutical Care Network Europe classification. A total of 404 patients with epilepsy were included. The prescription for an ASD was in accordance with the indication set in guidelines in 75.0% of population, and 1078 DRPs were identified. The main DRPs detected were adverse drug reactions (51.0%), inappropriate combinations of drugs (50.0%), and suboptimal drug regimens (46.3%). Single and divorced patients, who living in Mount Lebanon, and who took the old with the new generation had a less risk to have an inadequate prescription to guidelines. However, female gender, controlled epilepsy, multiple ASDs, and living in a rural region increased DRPs. This study showed that quarter of the population used ASDs contraindicated according to international guidelines. Since DRPs were related to the number and type of ASD prescribed, it is important to assess the case of each patient by a clinical pharmacist to prevent drug-drug interactions and iatrogenic issues.

The identification of drug related problems (DRPs) using profilaxis antibiotics in orthopedic surgical patients at a Government Hospital in Yogyakarta

Background: Antibiotic prophylaxis in orthopedic surgery cases aims to prevent surgery site infections (SSI). For antibiotic prophylaxis, it is recommended to use the first generation of cephalosporin, namely cefazolin which can kill the bacteria commonly found in orthopedic surgery infection. The prophylactic administration of cefotaxime is not the first line but is definitive for surgical prophylaxis. Objective: The aim of this study was to determine the rationale for the use of antibiotic prophylaxis for orthopedic surgery, the drug problems (DRPs) that occurred and their potential interactions. Method: This study was conducted using a cross sectional design with a total sampling technique of medical record samples from January to February 2019 at the Government Hospital in Yogyakarta. Observational analytical descriptive data processing by ensuring the appropriate of indications, route of administration, timing of administration and an appropriate of prophylactic doses as well as how to compare DPRs to the literature and analysis of potential co drug interaction with Drug Information Handbook (DIH), AHFS Clinical Drug Information, Drug Interaction Facts, and Interactions Stockley’s Drug Interaction. Results: All patients received appropriate therapy for indication, type of drug, routes of administration for pre and postoperative. All patients received an under dose of ranitidine and 1 patient (1,69%) received an over dose of piracetam. Potential interactions that occur include ketorolac-ranitidine, NSAIDs with other NSAIDs, NSAIDs-ranitidine, NSAIDs-ACEi, NSAIDs-bisoprolol, bisoprolol-calcium, calcium-vitamin C, and paracetamol-ranitidine. Conclusion: Pre and postoperative prophylactic antibiotics are rational. The accompanying drug, ranitidine and piracetam were not properly doses. Drug interactions in this study are potential. Keywords: prophylaxis antibiotic, orthopedic surgery, cefotaxim, DRPs

Identification and resolution of drug-related problems among diabetic patients attending a referral hospital: a prospective observational study

BackgroundPeople living with diabetes are more vulnerable to drug-related problems due to the presence of multiple diseases. This study aimed to identify drug-related problems and contributing factors among diabetic patients.MethodsThis study used a prospective observational study design. The study was conducted among diabetic patients during follow-up at Mettu Karl Referral Hospital from 15 April to 09 August 2019. The consecutive sampling was utilized to collect data. The identification of drug-related problems was performed using the Pharmaceutical Care Network Europe version 8.03. Following data collection, data were entered into Epidata manager version 4.4.2 and exported to the SPSS version 24.0 for analysis. Multivariable logistic regression analysis was done to identify predictors of drug-related problems.ResultsA total of 330 people with diabetes were included in the study, among whom 279 (84.5%) had at least one drug-related problem. A total of 455 drug-related problems were identified. Effects of drug treatment not being optimal (52.7%) and untreated symptoms or indications (30.1%) were the most commonly identified drug-related problems. About 865 interventions were provided for identified drug-related problems and 79.8% was accepted. Diabetes duration ge 7 years [AOR = 2.02; 95% CI (1.06, 3.85); p = 0.033] and the presence of comorbidity [AOR: 2.33; 95% CI (1.18, 4.60); p = 0.015] were factors identified as predictors of drug-related problems.ConclusionThe present study identified that drug-related problems are common among diabetic patients. Effects of drug treatment not being optimal and untreated symptoms or indications were the most commonly identified drug-related problems. Longer diabetes duration and the presence of comorbidities were predictors of drug-related problems.

Assessment of drug utilization review activities within United States colleges of pharmacy

IntroductionLimited literature exists regarding current practices in teaching and assessment of drug utilization review (DUR) skills in pharmacy schools. This manuscript aimed to: (1) examine how assessment is conducted for DUR activities using survey results and (2) summarize the assessment strategies of DUR activities via analysis of tools in colleges of pharmacy. MethodsA survey was administered to members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group via Qualtrics. Descriptive statistics were used to evaluate survey results and the assessment tools (i.e. rubrics/checklists) collected were analyzed qualitatively to determine common content areas. ResultsOut of the 113 institutions emailed, 48 (42.5%) responses were complete and represented individual colleges. Thirty-four of those 48 both implemented and assessed DUR activities. Fourteen institutions (41%) utilized one DUR assessment tool throughout the entire curriculum. The majority (62%) used the assessment tool in the first professional year, with a paper tool being the most frequently utilized (74%). “Identification of drug-related problems” (97%) and “determination of the pharmacist's action” (85%) were listed as important components of the assessment tool. Faculty noted that the assessment tool was easy to use (55%) and adequately assessed students' knowledge/skills (55%). A validated assessment tool (85%) and inclusion of technology (50%) would improve delivery of student feedback. ConclusionsWide variability existed in how schools incorporated and assessed DUR activities. Developing a standardized method of teaching and assessing DUR is important to adequately prepare the next generation of pharmacists.

Hubungan Drug Related Problems (DRPs) Obat Antidiabetika terhadap Ketercapaian Kendali Glikemik pada Pasien Rawat Inap Diabetes Melitus Tipe 2 dengan Komplikasi Nyeri Neuropati

Drug Related Problems (DRPs) associated with Type-2 Diabetes Melitus is commonly caused by multi drug prescription since Type-2 Diabetes Mellitus has comorbid dan complication diseases. Neuropathic pain has 50% prevalence of Type-2 diabetes Mellitus Complication. DRPs can cause can cause inadequate therapy that might be the risk factor leads to neuropathic pain. This study was aimed to investigate the association between drug related problems of antidiabetic medication with glicemic control of hospitalized type 2 diabetes melitus with neuropathic pain patients. Cohort-study is used in this study. 50 patients were conducted in this study that underwent Hospital treatment at Rumah Sakit Akademik Universitas Gadjah Mada during the periods of 2018-2019. This study involved 50 patients who were divided into groups that experienced DRPs by 36 patients and non DRPs by 14 patients. All of the 50 has meet the inclusions criterias. Statistical analysis was using Chi-square test 95% confidence interval (p < 0.05). A number of 38 DRPs have found consists of 26,3% need more therapy, 55,2% with wrong drug therapy, 18,4% inadequate dosing. There was an association between DRPs of antidiabetics regiments and glycemic target on Type-2 Diabetes Mellitus patients with neuropathic pain complication (p=0,005). Identification of DRPs is needed to prevent the negative effect of patient therapy outcomes.

Medication Review by Community Pharmacists for Type 2 Diabetes Patients in Routine Care: Results of the DIATHEM-Study.

Most elderly patients with type 2 diabetes take multiple drugs. Earlier studies in other countries suggested that interdisciplinary medication reviews are beneficial for these patients regarding medication safety and therapy optimization. In Germany, medication reviews by community pharmacies are rarely performed, although it is a service stipulated in the “Apothekenbetriebsordnung” (rules governing the operation of pharmacies in Germany) since 2012. Therefore, the aim of the DIATHEM study (type 2 DIAbetes: optimizing THErapy by Medication review in community pharmacies) was to evaluate the impact of medication reviews from German community pharmacies under real-life conditions. Primary outcomes were: identification of drug related problems (DRPs) and to evaluate to what extent they could be solved by the medication review. Secondary outcomes were: evaluation of changes in the number of drugs and the interdisciplinary cooperation between pharmacists and physicians. In a single arm interventional study, 121 patients aged 65 or older with type 2 diabetes, taking at least five drugs for long-term treatment were provided with one medication review between February 2016 and April 2017. Physicians were not pre-informed about the review and neither patients nor physicians nor the 13 participating community pharmacies were reimbursed for their contributions to the study. For 121 patients, 586 DPRs were identified (4.84 DRPs per patient) of which 31.6% were related to the antidiabetics. Due to the medication review, 46.9% of these DRPs could be completely resolved, indicating a statistically significant decline from 4.84 DRPs to 2.57 DRPs per patient (p < 0.001). The average number of drugs was significantly reduced from 9.5 drugs (standard deviation, SD = 2.9) to 9.3 drugs (SD = 2.8) per patient (p < 0.001). The pharmacists received feedback for 76.7% of the intervention proposals sent to the physicians. In total 59.5% of the intervention proposals were accepted, of which 643 (85.3%) were accepted and fully implemented. In conclusion, the study shows that medication reviews performed by community pharmacists under routine care conditions reduced the frequency and number of DRPs, even though the pharmacies had to face obstacles such as lack of cooperation by the prescriber or lack of reimbursement.

Content and impact of pharmacy services for patients with Parkinson's disease: A systematic review and meta-analysis.

Medicines optimisation is important for the management of Parkinson's disease (PD). As many patients with PD have other long-term conditions, treatment is complex and risk of adverse events for these patients is high. To explore the role of pharmacists and impact of pharmacy interventions for PD patients. We comprehensively searched PubMed, Embase, the Cochrane Library and Chinese databases Sinomed, China National Knowledge Infrastructure to identify studies reporting pharmacist interventions and pharmacy services for PD patients using a predefined search strategy. The search period was from inception to March 2019. We also manually searched the reference list of included studies and ClinicalTrials.gov. We conducted meta-analyses to synthesize the evidence quantitatively. A total of 1607 studies were identified by applying the search criteria. After screening, 19 cross-sectional and case-controlled studies with 1458 PD patients from 9 countries were included. Pharmacist interventions for PD patients most commonly related to adverse drug reactions (ADRs) (13 studies), adherence assessment (12 studies), medication review (12 studies), identification of drug interactions (11 studies), monitoring response to medication therapy (11 studies), identification of inappropriate medication (11 studies), and patient education (10 studies). Most pharmacy services were provided in outpatient settings (13 studies). Reported impact measures included adherence (8 studies), quality of life (7 studies), and identification of drug-related problems (6 studies) such as ADRs (393 times out of 1760 times, 22.33%, 6 studies), inappropriate drug choice (349 times, 19.83%, 6 studies), inappropriate dosage (335 times, 19.03%, 6 studies), inappropriate drug use (257 times, 14.60%, 3 studies) and drug-drug interactions (146 times, 8.3%, 4 studies). Pooled results from 3 studies indicated no statistically significant impact of pharmacy services on all subscales of PD Questionnaire-39. ADRs were the most widely reported drug-related problems for PD patients; pharmacy services may have a role to play in medication adherence but were not found to impact on quality of life.

Pharmacy Technicians' Contribution to Counselling at Community Pharmacies in Denmark.

(1) Background: pharmacy technicians are the largest group of staff at Danish community pharmacies and play a vital role in counselling customers on prescription medication, over-the-counter (OTC) medication and non-medical products. This is the first study carried out to specifically analyse how they contribute to counselling and identification of drug-related problems (DRPs) at Danish community pharmacies. (2) Methods: seventy-six pharmacy technicians from 38 community pharmacies registered data on all of their customer visits for five days, over a four-week period, between January and March 2019. Data were analysed in SPSS version 24. (3) Results: 58.9% of all registered customers (n = 10,417) received counselling. They identified DRPs for 15.8% of all registered customers (n = 2800). Counselling by pharmacy technicians solved, or partially solved, problems for 70.4% of customers with DRPs. Pharmacy technicians estimated that 25.2% of customers receiving counselling (n = 2621) were saved a visit to the general practitioner (GP). (4) Conclusions: as community pharmacists get more involved in complex services, it would be necessary to expand the roles of pharmacy technicians. Pharmacy technicians contribute to medication safety via counselling, and identifying and handling DRPs for all customers. This study documents the role of pharmacy technicians in customer counselling at Danish community pharmacies. It provides evidence to researchers and policy makers to support discussions on the future role of pharmacy technicians at community pharmacies.

Фармакотерапія гострого вірусного гепатиту В: погляд клінічного провізора

Aim. To conduct the analysis and estimation of acute viral hepatitis B pharmacotherapy through identification of drug-related problems; to form a list of recommendations with elements of pharmaceutical care concerning some aspects of acute viral hepatitis B pharmacotherapy. Materials and Methods. The objects of research: 27 medical records of patients with acute viral hepatitis B who were hospitalized to one of Lviv City Hospitals in the first quarter of 2016; medical and technological documents on acute viral hepatitis B management; results of clinical research and clinical case reports; The Pharmaceutical Care Network Europe classification (version 5.01) for drug-related problems. Methods: systemic approach, clinical-pharmaceutical, clinical-pharmacological, statistical, and analytical. Results and Discussion. All patients with acute hepatitis B received only pathogenetic and/or symptomatic pharmacotherapy which corresponds to modern scientific approaches of rational pharmacotherapy of acute hepatitis B. The total number of identified drug-related problems was 192 (a mean of 7,1±1,4 drug-related problems per patient), out of them: 30,1% - potential drug-drug interactions; 27,5% - insufficient dosage of drugs; 14,6% - co-administration of medications with the same active ingredients (duplicate prescriptions); 11,5% - excessive duration of pharmacotherapy; 6,3% - incorrect drugs; 4,7% - incorrect route of drug administration; 1,6% - contraindicated use of drugs; 1,6% - excessive dosage of drugs; 1,6% - technical drug-related problems; and 0,5% - insufficient duration of pharmacotherapy. Conclusions. According to the results of this study, the list of clinical pharmacist's recommendations (messages of pharmaceutical care) have been formed which can be used for improving the quality and safety of pharmacotherapy. Key words: clinical pharmacist, acute viral hepatitis B, drug-related problems, rational pharmacotherapy

Evaluation of process indicators of a medication review service between pharmacists and physicians

Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.

A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan

BackgroundThe role of a pharmacist in primary health care settings of Pakistan is still obscure. Thus, we aimed to demonstrate the pharmacist-led improvements in glycemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients of Lahore, Pakistan.MethodsThe first open label, randomized control trial conducted at a primary health care facility of Lahore, Pakistan by enrolling 244 uncontrolled type 2 diabetes (hemoglobin A1 c, (HbA1c); 10.85 ± 1.74) patients. The pharmacological intervention included identification of drug related problems, drug interactions, change in dose, frequency and therapy switches in collaboration with physician, while non-pharmacological intervention consisted of diet, lifestyle and behavior counseling. Outcome measures were glycemic (HbA1c), blood pressure and lipid controls.ResultsIn intra-group comparison, compared to control arm (C, n = 52), subjects in the intervention arm (I, n = 83) demonstrated significant differences in process outcome measures; baseline vs final, such as HbA1c (C; 10.3 ± 1.3 vs 9.7 ± 1.3, p < 0.001, I; 10.9 ± 1.7 vs 7.7 ± 0.9, p < 0.0001), systolic blood pressure (SBP) (C; 129.9 ± 13.9 vs 136 ± 7.1, p = 0.0001, I; 145 ± 20.4 vs 123.9 ± 9.9 mmHg, p < 0.0001), diastolic blood pressure (DBP) (C; + 4, p = 0.03, I; − 7 mmHg, p < 0.0001), cholesterol (C; 235.8 ± 57.7 vs 220.9 ± 53.2, p = 0.15, I; 224 ± 55.2 vs 153 ± 25.9 mg/dL, p < 0.0001), triglycerides (C; 213.2 ± 86.6 vs 172.4 ± 48.7, p = 0.001, I; 273 ± 119.4 vs 143 ± 31.6 mg/dL, p < 0.0001) and estimated glomerular filtration rate (eGFR) (C; 77.5 ± 18.6 vs 76 ± 14.2, p = 0.5, I; 69.4 ± 21.3 vs 93.8 ± 15.2 ml/min/1.73m2, p < 0.0001). Likewise, inter-group improvements were more significant in the subjects of intervention group at final follow up in comparison to control for various process outcome measures; HbA1c (p < 0.001), SBP (p < 0.0001), DBP (p = 0.02), cholesterol (p < 0.0001), triglycerides (p < 0.0001), SCr (p < 0.001), eGFR (p < 0.001). Moreover, both male and female subjects exhibited similar responses towards intervention with similar improvements in outcome measures.ConclusionThese data suggested that pharmacist intervention in collaboration with physician in primary health care settings may result in significant improvements in glycemic, blood pressure and lipid controls in Pakistani population.Trial registrationThe trial was registered retrospectively with International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry on July 26, 2017 under nutritional, metabolic, endocrine category with assigned registration # ISRCTN22657497 and can be assessed at https://doi.org/10.1186/ISRCTN22657497

Study of Prescribing Pattern, Identification of Drug Related Problems and Therapeutic Intervention in Cardio Vascular Diseases (CVD) Patients

Cardiovascular disease (CVD) is a disorder of heart and blood vessels. CVD is one of the major causes of deaths in India, which contributed around 30 to 40%. The aim of the study was to study the prescribing pattern of drugs, identification of drug related problems and therapeutic intervention in CVD patients. A hospital based prospective and observational study was carried out for a period of nine months in a south Indian tertiary care hospital. Among 120 selected patients, 79 were male (65.83%) and 41 were female (34.16%), more number of patients (35) were between the age group of 55-64 (29.16%) of which 27 were males &amp; 8 were females, and very less number of patients (6) were between the age group 85-94 (5%) of which all the 6 were male. Hypertension is the most commonest and dominant disorder, which affected 47(39.16%) patients, in which 30 were male (25%) and 17 were female (14.16%). Most common risk factor is HTN followed with smoking and diabetes of 45 patients (37.5%). The most often prescribed pattern adopted in CVD is Dual therapy, it is most frequently used therapy 50 (41.66%) and quadruple therapy is less frequently 6(6.5%) used. The diuretics and calcium channel blocker combination were maximally prescribed class of drugs as a dual therapy. A total of 47 drug-drug interactions were found, among 12 were major, 15 were moderate and 20 were minor interactions. Clinical pharmacist has intervened with the help of other health care professionals in order to reduce the risk factor and minimise the drug-drug interactions. The study provides the benefits of presence of clinical pharmacist in a hospital setting, in order to prevent the medication related errors and provide the expertise pharmacotherapy opinion in CVD patients, which improves the patient compliance. Hence study justifies a need of active collaboration between clinical pharmacist, physician and other health care professionals for the better management of CVD patients.&#x0D; Keywords: Prescribing Pattern; Cardio Vascular Diseases; Drug Related Problems; Therapeutic Intervention.

Contribution of Patient Interviews as Part of a Comprehensive Approach to the Identification of Drug-Related Problems on Geriatric Wards.

Inappropriate prescribing is linked to increased risks for adverse drug reactions and hospitalisation. Combining explicit and implicit criteria of inappropriate prescribing with the information obtained in patient interviews seems beneficial with regard to the identification of drug-related problems (DRPs) in hospitalised patients. We aimed to investigate the inclusion of pharmacist interviews as part of medication reviews (including the use of explicit and implicit criteria of inappropriate prescribing) to identify DRPs in older inpatients. Clinical medication reviews were performed on geriatric and associated physical and neurological rehabilitation wards in a regional secondary care hospital. Data from electronic medical records, laboratory data, and current treatment regimens were complemented with a novel structured patient interview performed by a clinical pharmacist. The structured interview questioned patients on administration issues, prescribed medication, self-medication, and allergies. The reviews included the use of current treatment guidelines, the Medication Appropriateness Index, the Screening Tool of Older People's Prescriptions (STOPP, v2), and the Screening Tool to Alert to Right Treatment (START, v2). The potential relevance of the DRPs was estimated using the German version of the CLEO tool. In 110 patients, 595 DRPs were identified, averaging 5.4 per patient (range 0-17). The structured interviews identified 249 DRPs (41.8%), of which 227 were not identified by any other source of information. The majority of DRPs (213/249, i.e. 85.5%) identified by patient interview were estimated to be of minor clinical relevance (i.e. limited adherence, knowledge, quality of life, or satisfaction). We demonstrated that structured patient interviews identified additional DRPs that other sources did not identify. Embedded within a comprehensive approach, the structured patient interviews were needed as data resource for over one-third of all DRPs.