Management Of Drug-related Problems Research Articles

Pharmacist's Impact on Medication Adherence and Drug-Related Problems in Patients with Epilepsy.

Drug-related problems (DRPs) and non-adherence are important barriers to ensuring optimal antiseizure drug treatment. The aim of this study was to improve medication adherence, detect and manage DRPs, and decrease the number of seizures with pharmacist-led education in patients with epilepsy. A prospective and interventional study was conducted in collaboration with the Department of Neurology, the rational drug usage unit of a hospital pharmacy in a university hospital. The impact of pharmacist-led education on medication adherence and interventions in the management of DRPs was assessed in patients with epilepsy who were admitted to the outpatient clinic. A total of 39 patients with epilepsy were evaluated in terms of medication adherence, DRPs, and seizure control over a 2-month follow-up period and patient satisfaction with pharmacy services at the end of the study. A total of 59 DRPs were detected, and 71.2% of them were accepted and implemented both by physicians and/or patients. Pharmacist interventions solved 62.7% of DRPs. The number of patients with high-level medication adherence significantly increased from 17 to 28 after pharmacist-led education (p < 0.001). The number of seizures decreased in 19 patients (48.7%) during the 2-month period. Patient satisfaction was high in all patients. It is shown that the contribution of pharmacists in treating patients with epilepsy is beneficial in improving medication adherence, detection and management of DRPs, and decreasing the number of seizures.

The identification and management of drug-related problems in the emergency department: a narrative review

The identification and management of drug-related problems in the emergency department: a narrative review

Assessment of Drug Related Problems and Pharmacist Interventions in Inpatients with Cardiovascular Disease

Aim. To identify and evaluate the nature and incidence of drug-related problems (DRPs) and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Material and Methods. An Observational and Prospective study was conducted in a tertiary care hospital of medicine department of general and intensive/critical care units for a period of 6 months to identify and evaluate the nature and incidence of DRP’s and to manifest the role of a pharmacist in ensuring safe and efficient use of medications with cardiovascular disease patients by using PCNE Classification to assess and report drug-related problems.Results. Of 94 Patient profiles were evaluated out of which 78 (82.9%) patient profiles were identified with 208 DRPs. Among 208, 140 (67.3%) drug interactions, 15 (7.2%) untreated indication, 12 (5.8%) adverse drug reactions, 10 (4.8%) drug use without indication, 8 (3.8%) drug underused, 8 (3.8%) duration of treatment too short, 5 (2.4%) dose unclear, 4 (1.9%) inappropriate drug form, 3 (1.4%) duration of treatment too long, 2 (1.0%) too many drugs prescribed for an indication, 1 (0.5%) drug overused. For 208 DRPs identified and provided with 74 interventions which includes 30 (41.6%) drug discontinuation, 24 (33.3%) addition of a new drug, 4 (5.55%) change of dosage form, and 14 (19.4%) decrease the dose.Conclusion. The present study revealed that patients with cardiovascular diseases suffer from numerous DRPs that can be identified, resolved, or prevented to some extent by pharmacist intervention. Hence the study addresses the importance of clinical pharmacist in the management of DRPs among cardiovascular patients.

Impact of pharmacist-led interventions on patient care in ambulatory care settings: A systematic review.

In an era of rapid evolution in healthcare delivery, major changes have occurred within the profession of pharmacist. Because the impact of pharmacist-led interventions in the hospital setting has been well-studied and showed mixed findings on drug-related readmissions, all-cause emergency department visits and mortality, this systematic review focused on services provided by pharmacists in the community or ambulatory care setting without being limited to a specific intervention or outcome. To investigate the impact of pharmacist-led interventions, categorised into clinical medication review (CMR), adherence review (AR), and prescription review (PR) on various aspects of patient care (clinical, behavioural, economic and humanistic outcomes in ambulatory care setting) and understand which particular intervention makes the greatest contribution. A literature search was conducted using MEDLINE, Embase and the Cochrane Library for publications from 2000 onwards. A total of 31 relevant publications corresponding to 27 controlled trials (CTs) and 4 observational studies were selected. CMR was the most studied pharmacist-led intervention (n=19, 61.29%), followed by AR (n=6, 19.3%). CMR demonstrated a favourable effect on different clinical outcomes mainly the management of drug-related problems and adverse events, and it also contributed the most to the reduction of healthcare costs. AR was the most effective intervention to improve patient's adherence. CMR alone or combined with AR both raised equally the patient's satisfaction. Our results showed that CMR can play a major role in the management of drug-related problems and economic issues. AR can significantly improve patient compliance. Larger, standardised and rigorously designed intervention studies are needed to help decision-makers to select appropriate interventions leading to meaningful improvements in patient care.

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

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

Cross-cultural adaptation of the PAIR instrument: Pharmacotherapy Assessment in Chronic Renal Disease for application in Brazil

Individuals suffering from chronic kidney disease (CKD) are often on multiple medications, which exposes them to drug-related problems (DRP). There are no available tools in Brazil to assess the pharmacotherapy and management of DRPs systematically in this population. The scope of this study was to perform a cross-cultural adaptation of PAIR criteria (Pharmacotherapy Assessment in Chronic Renal Disease) to Brazilian Portuguese. PAIR criteria consist of 50 DRP clinically significant items for CKD. The process of cross-cultural adaptation involved translation, synthesis, back-translation, and an analysis by an expert committee as well as a pre-test of the first draft document. A review committee consisting of 2 pharmacists and 2 nephrologists analyzed the semantic, linguistic, experiential, and conceptual equivalence between the original and translated versions. All items that obtained a score below 80% were reviewed. Word adjustments were made, as well as the exclusion of 6 DRP due to non-applicability to the Brazilian context. Thus, the final version of PAIR defined as "Avaliação da farmacoterapia na doença renal crônica" was translated and adapted into the Brazilian Portuguese language.

Improving community pharmacists' clinical knowledge to detect and resolve drug-related problems in Croatia: a before/after survey study investigating the efficacy of an educational intervention.

ObjectivesThe aim of this study was to increase the knowledge level of community pharmacists in Croatia to identify and resolve drug-related problems (DRPs).DesignBefore/after survey study.SettingUniversity of Split School of Medicine.Participants115 community pharmacists from all over the Croatia.InterventionsAn interactive 3-day clinical pharmacy workshop with the goal of increasing the knowledge level of community pharmacists in Croatia to identify and resolve DRPs in routine practice. Teaching methods were based on interactive clinical case solving.Outcome measureChange of the community pharmacists’ knowledge based on preworkshop and postworkshop evaluation. A survey-based clinical knowledge measurement tool was used in order to evaluate the efficacy of the workshop. The lowest possible total score was 0 and the highest was 80. A higher survey score indicates a higher level of clinical knowledge to identify and resolve DRPs.ResultsParticipating pharmacists had significantly higher postworkshop mean survey score (49.1±8.0) than the preworkshop mean survey score (42.9±8.2), with the mean score difference of 6.2 (95% CI 4.3 to 8.1). Furthermore, it was found that community pharmacists significantly increased their survey scores, regardless of their age.ConclusionsInteractive and case-based clinical pharmacy workshop could be a valuable tool to increase the knowledge of community pharmacists about identification and management of DRPs in routine practice. However, further studies are necessary to evaluate the long-term knowledge maintenance and the improvement in patients’ clinical outcomes.

Evaluation of Drug-Related Problems in a Pediatric Bone Marrow Transplantation Unit Identified by a Clinical Pharmacist in-training in a 7-Month Period

Objective: This cross sectional study was performed to demonstrate the importance of clinical pharmacists’ participation in pediatric hematopoietic stem cell transplantation patient management with regards to the detection, prevention, and management of drug-related problems.Methods: The study was carried out from 1st October 2015 to 1st May 2016 in a pediatric bone marrow transplantation unit of a tertiary care hospital. The inpatients and outpatients between 0 to 18 years of age were included and the patients were monitored and evaluated for drug-related problems (interactions, side effects, preparation, and administration). A clinical pharmacist-in-training made recommendations to the physicians and the nurses on the problems that were identified.Results: Twenty inpatients and twenty-two outpatients were monitored during the study. In total, 245 problems were identified in the inpatients, 37.14 % of which were drug-related; 33 % of the drug-related problems were the side effects of cyclosporine. Eleven recommendations on drug-related problems were made to the physicians and six of them were for the problems identified in the inpatient services with regards to drug dosing and administration. Five recommendations regarding total parenteral nutrition, drug incompatibility, drug administration from the feeding tube, and drug side effects were made to the nurses. Twenty-nine information on the dosing, side effects, incompatibilities, administration, and preparation of the drugs, were given by the pharmacist to the physicians and the nurses.Conclusion: Clinical pharmacists’ participation will improve the detection and the management of drug-related problems in pediatric hematopoietic stem cell transplantation units in Turkey.

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil.

Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

Clinical Pharmacy Activities Documented (ClinPhADoc): Development, Reliability and Acceptability of a Documentation Tool for Community Pharmacists.

Documentation of community pharmacists’ clinical activities, such as the identification and management of drug-related problems (DRPs), is recommended. However, documentation is not systematic in Swiss community pharmacies, and relevant information about DRPs, such as consequences or involved partners, is frequently missing. This study aims to evaluate the interrater and test-retest reliability, appropriateness and acceptability of the Clinical Pharmacy Activities Documented (ClinPhADoc) tool. Ten community pharmacists participated in the study. Interrater reliability coefficients were computed using 24 standardized cases. One month later, test-retest reliability was assessed using 10 standardized cases. To assess the appropriateness, pharmacists were asked to document clinical activities in their own practice using ClinPhADoc. Acceptability was assessed by an online satisfaction survey. Kappa coefficients showing a moderate level of agreement (>0.40) were observed for interrater and test-retest reliability. Pharmacists were able to document 131 clinical activities. The good level of acceptability and brief documentation time (fewer than seven minutes) indicate that ClinPhADoc is well-suited to the community pharmacy setting. To optimize the tool, pharmacists proposed developing an electronic version. These results support the reliability and acceptance of the ClinPhADoc tool.

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.

Prevalence and Management of Drug-Related Problems in Chronic Kidney Disease Patients by Severity Level: A Subanalysis of a Cluster Randomized Controlled Trial in Community Pharmacies.

Drug-related problems (DRPs) are prevalent among chronic kidney disease (CKD) patients. However, little is known about their severity and management by community pharmacists. To (a) describe the prevalence of DRPs by severity level in CKD patients and (b) assess the effect of a training-and-communication network program in nephrology (ProFiL) on these DRPs. This is a secondary analysis of a cluster randomized controlled trial evaluating the effect of the ProFiL-program. In 6 CKD clinics, patients at CKD stage 3 or 4 and their community pharmacists were recruited and assigned to the ProFiL group or a usual care (UC) group. Using validated criteria, 2 pharmacists identified DRPs and assessed their severity at baseline and after 12 months. The mean annual change in the number of DRPs per patient by severity level was assessed using a 2-level multivariable linear mixed-effects model. A total of 494 pharmacists and 442 patients participated. At baseline, the prevalence (mean number of DRPs per patient [SD]) of mild DRPs (e.g., requiring dosage adjustment) and moderate DRPs (e.g., drug adherence requiring a monitoring plan) were 0.55 (0.98) and 1.04 (1.51), respectively. After 12 months, an unadjusted incremental annual reduction of 0.34 moderate DRPs (95% CI = -0.66 to -0.01) was observed in the ProFiL group compared with the UC group. After adjustment, no between-group differences were observed. Among patients followed in CKD clinics, most DRPs have a moderate severity requiring specific monitoring by pharmacists. The benefit of continuing education programs, such as ProFiL, to reduce moderate DRPs remains to be determined. This study was supported by the Canadian Institutes of Health Research (grant number: MOP-230207). Part of the study was also funded by Pfizer Canada, Leo Pharma, and Amgen. The authors declare that they have no relevant financial interests. Study concept and design were contributed by Quintana-Bárcena, Lord, and Lalonde. Quintana-Bárcena, Lord, and Lizotte were responsible for the data analysis, and Quintana-Bárcena and Berbiche performed the statistical analysis. The manuscript was written by Quintana-Bárcena and Lalonde and revised by Quintana-Bárcena and Lalonde, along with the other authors.

Clinical knowledge of community pharmacists in Croatia for detecting drug-related problems.

Background Drug-related problems (DRPs) interfere with patient's health outcomes and have a negative impact on healthcare resources. Successful management of DRPs is an essential part of pharmaceutical care. Pharmacists should have adequate clinical knowledge in order to effectively implement pharmaceutical care and manage DRPs. Objective To determine the clinical knowledge of community pharmacists in Croatia to detect and resolve DRPs. Method A sample of 302 community pharmacists have anonymously and voluntarily completed the validated survey-based clinical knowledge measurement tool. For each completed survey, all statements were scored individually, and a total score was calculated. The lowest possible total score was 0 and the highest was 80. Higher survey score indicates a higher level of clinical knowledge to detect and resolve a DRP. Results All community pharmacists had a mean score of 45.5±8.6, while pharmacists from a pharmacy chain with mandatory education had a higher mean score of 50.2±6.5. Multivariate linear regression revealed that only additional education (β=0.272, p<0.001) is associated with a higher mean score, while age and gender have no influence on the survey score. Conclusion Additional education of community pharmacists could increase their clinical knowledge to detect and resolve DRPs.

EPICC study: evaluation of pharmaceutical intervention in cancer care.

In cancer care, clinical pharmacists contribute to improving prevention and management of drug-related problems (DRPs). The 3-year EPICC study (Evaluation of Pharmaceutical Intervention in Cancer Care) aimed to collect and analyse pharmaceutical interventions (PIs) in oncology. The free online version of the French Society of Clinical Pharmacy (SFPC) coding system, ACT-IP, was used, supplemented by a standardized dedicated cancer-care decision tree. A total of 29,589 medication orders (77,004 anticancer drug preparations) were analysed. Eight hundred and ninety-four PIs were recorded. ACT-IP identified 54·1% of DRPs as concerning over- or underdosage. The standardized dedicated cancer-care decision tree identified the three principal causes of dosage problems: 50·2% due to miscalculation, 20% to omission of dose adjustment and 12% to poor choice of antineoplastic regimen. About 13·8% of DRPs were adverse effects and 3·9% were drug-drug interactions. The decision tree showed that 22% of adverse events could be circumvented by a switch within the same drug family and 72% of drug-drug interactions would have led to increased neoplastic toxicity. Pharmaceutical analysis of prescription forms contributes to medication safety in cancer care, and the present dedicated decision tree highlights additional information about DRPs and PIs. The DRP rate (3% of prescriptions) was consistent with the literature. The pharmacist has a role to play in optimizing the management of patients with cancer in terms of dose adjustment, drug toxicity management, improvement of administration and drug-drug interactions. This study, highlighting PIs in cancer care, is the first of this scale in terms of number of prescriptions analysed (nearly 30 000). Results demonstrated the specificity of DRPs and PIs for patients with cancer and the value of a dedicated coding system in cancer care.

CPC-114 Prevalence and Management of Drug-Related Problems in an Intensive Care Unit

BackgroundPatients admitted to intensive care units (ICUs) are at higher risk than other patients of having problems, injuries and adverse drug reactions (ADRs) associated with their drug treatment.Purpose To identify...

Drug related problems in type 2 diabetes patients with hypertension: a cross-sectional retrospective study

BackgroundType 2 diabetes (T2DM) patients with hypertension are at increased risk for experiencing drug-related problems (DRPs) since they often receive multiple medications and have multiple comorbidities. To date, there is a lack of studies conducted in T2DM patients with hypertension. This study aims to analyze the DRPs and identify factors affecting the DRPs in this patient population.MethodThis retrospective study involved T2DM patients with hypertension and was conducted at a tertiary hospital in Malaysia from January 2009 to December 2011. The assessment of DRPs was based on the Pharmaceutical Network Care Europe (PCNE) tool version 5.01.ResultsTwo hundred patients with a total of 387 DRPs were identified. Among these patients, 90.5% had at least one DRP, averaging 1.9 ± 1.2 problems per patient. The most common DRPs encountered were insufficient awareness of health and diseases (26%), drug choice problems (23%), dosing problems (16%) and drug interactions (16%). The most implicated drugs were aspirin, clopidogrel, simvastatin, amlodipine and metformin. The six domains of DRPs found to have statistically significant associations were renal impairment, polypharmacy, cardiovascular disease, elderly status, and duration of hospital stay.ConclusionsEarly identification of the types and patterns of DRPs and the factors associated to them may enhance the prevention and management of DRPs in T2DM patients with hypertension.

Impact of collaborative and multidisciplinary care on management of hypertension in chronic kidney disease outpatients

Objective In patients with chronic kidney disease (CKD), blood-pressure (BP) control is crucial. ProFiL, a training and communication-network programme, is designed to optimize community pharmacists' management of drug-related problems among CKD outpatients. This study evaluates the impact of ProFiL on BP control and management of hypertension treatment. Methods In a 6-month cluster randomized trial, community pharmacies of CKD outpatients (creatinine clearance, <60 ml/min) attending a predialysis clinic in Quebec, Canada, were randomly assigned to ProFiL (intervention) or usual care (UC). ProFiL community pharmacists attended a training workshop, received patient information and had access to a hospital-pharmacist consultation service. UC pharmacists provided routine care. Key findings Eighty-nine patients (ProFiL, 48; UC, 41) participated. At 6 months, adjusted mean systolic/diastolic BP changes, taking within-cluster correlation into account, were −6.9/−0.4 mmHg in ProFiL patients compared with +4.7/+2.2 mmHg in UC (between-groups differences, P value = 0.021/0.348). Some 41 hypertension drug-related problems were identified. Community pharmacists wrote 25 recommendations (ProFiL, 24; UC, 1; P value = 0.007), 12 of which, all by ProFiL pharmacists, dealt with hypertension (P value = 0.009 compared with UC). Patients with written hypertension recommendations had a greater decrease in mean systolic BP (−11.6 mmHg; P value = 0.035), and BP was controlled in a higher proportion of them (relative risk, 2.14; P value = 0.011). Conclusion ProFiL, a collaborative and multidisciplinary care programme, may help pharmacists to intervene more often to detect and manage hypertension drug-related problems and optimize BP control in CKD outpatients.

Classification of drug-related problems with new prescriptions using a modified PCNE classification system

To explore and classify drug-related problems (DRPs) with new prescriptions detected in community pharmacies using a modified PCNE (Pharmaceutical Care Network Europe) classification system. Sixty-four Swiss community pharmacies offering internships for pharmacy students. Occurrence, nature and pharmacist's management of DRPs. Fifth-year pharmacy students collected consecutively hospital discharge and primary care prescriptions. After training, they documented clinical and technical DRPs, causes and interventions. Prescriptions of 616 patients (43.0% discharged from hospital) were analysed. The patients' median age was 56 years and they received a median of 3 (range 2-19) different drugs. In 121 (19.6%) prescriptions 141 clinical DRPs were detected. The most frequent clinical DRPs were potential drug-drug interactions (DDIs) (37.6%), drug choice (24.8%) and drug use problems (15.6%). These clinical DRPs led to a total of 299 interventions. There were 222 prescriptions (36.0%) that showed 278 technical DRPs, resulting in a total of 417 interventions. Most frequent technical DRPs were missing or unclear package size or therapy duration (32.7%) and missing or unclear dosing/application instructions (30.9%). Most DRPs (75.4%) could be managed by the pharmacist alone. The number of prescribed drugs was the main factor with an influence on the frequency of clinical and technical DRPs. Clinical and technical DRPs are frequently observed in primary care as well as in hospital discharge prescriptions. The modified PCNE classification system, especially the amendment with a technical DRP category, proved to be useful and allowed the classification of all DRPs. Neither the setting (hospital discharge vs. primary care) nor the quality of electronically printed prescriptions, but only the number of prescribed drugs influenced the occurrence of clinical or technical DRPs.

Pharmaceutical care for HIV patients on directly observed therapy.

Inner-city patients infected with HIV can be a challenging group to treat. Homelessness, mental illness, substance abuse, and hepatitis C infection may serve as barriers to effective treatment. A multidisciplinary team including the pharmacist can impact upon the delivery of care to the inner-city HIV patient population. To describe the implementation and provision of pharmaceutical care to inner-city patients taking directly observed therapy (DOT), as well as drug-related problems (DRPs) and their respective outcomes. Pharmaceutical care, including the prospective identification and management of DRPs, was provided by a clinical pharmacist. Fifty-seven patients were followed over a 14-month period. Overall, 149 DRPs were identified and >95% were resolved. Those included (1) adverse effects (n = 56; gastrointestinal, central nervous system effects, allergies, laboratory abnormalities), (2) drug interactions (n = 32), (3) drugs indicated for comorbidities (n = 24; safety in pregnancy, tuberculosis, Pneumocystis carinii pneumonia prophylaxis, oral candidiasis, herpes zoster, nutritional supplements), (4) adherence issues (n = 20; altering timing of medication, changing formulation, decreasing pill burden), (5) drugs no longer indicated (n = 10; opportunistic infection prophylaxis, treatment of primary infection), and (6) dosage adjustment (n = 7) for weight and renal insufficiency. In the provision of pharmaceutical care to HIV-infected patients on DOT, an HIV pharmacist significantly contributed to antiretroviral selection, monitoring of drug therapy, and managing DRPs. An HIV pharmacist can assist in promoting patient adherence and improved outcomes in this setting.

Pharmacist's management of drug-related problems: a tool for teaching and providing pharmaceutical care.

During the development of education and practice models based on the philosophy of pharmaceutical care (PC), six pharmacists worked with the University of Toronto Faculty of Pharmacy to implement the PC model in their practice sites. These pharmacists found it necessary to modify existing tools to create one that explicitly guided them through the PC process, including the phase of monitoring patients for desired outcomes. This resulted in the development of the Pharmacist's Management of Drug Related Problems. This tool requires pharmacists to collect patient drug and medical data and write responses to specific questions about the data to interpret their significance. As proficiency in providing PC is attained, the questions and space for written responses can be eliminated, leaving a comprehensive documentation system of patient outcomes and the data collected, recommendations made, and monitoring completed by the pharmacist. This tool has been adopted by the University of Toronto Faculty of Pharmacy and is being used in various continuing education programs and by practicing pharmacists across Canada.