Resolution Of Drug-related Problems Research Articles

Identification and resolution of drug-related problems among neonates in neonatal intensive care unit (NICU): A prospective longitudinal observational study

BackgroundDrug related problems (DRPs) can interfere with the desired therapeutic outcomes. Neonates are susceptible for DRP occurrence due to clinical heterogeneity, inappropriate formulations, complexity of drug regimens and polypharmacy. Thus, the objective of this study was to characterize the DRP, their resolutions and associated risk factors among neonates in the Neonatal Intensive Care Unit (NICU). MethodsA cross-sectional study was carried out in NICU ward at tertiary care teaching hospital for 18 months. Clinical pharmacists participated on daily basis to collect patient information and assess their medication therapy for DRPs. DRPs were classified into problems and their causes according to Pharmaceutical Care Network Europe (PCNE) Version 9.1. Clinical pharmacist implicated evidence-based interventions to resolve DRPs. SPSS V.25 was used for the statistical analysis. Univariate logistic regression analysis was used for the determination of risk factors for DRPs, with a p-value <0.05 for associations that were statistically significant. ResultsA total of 426 neonates were enrolled with a mean gestational age of 35.2 ± 7.5 weeks and a mean birth weight of 2316 ± 1814 g. A total of 486 DRPs were found among 55.6 % neonates. Among them, majority of DRPs were belongs to treatment effectiveness [n = 427 (87.8 %)]. In total, 559 interventions were made, resulting in the resolution of 87.4 % of the DRPs. Furthermore, neonates staying in hospital for more than 5 days identified as most significant risk factor of DRPs. ConclusionDRPs are common in neonates admitted to NICU. Clinical Pharmacist can play significant roles in identifying, preventing and resolving DRPs among neonates.

Improving the impact of pharmacy interventions in hospitals

The clinical and pharmaceutical interventions of pharmacy professionals are considered impactful inputs towards optimised patient care and safety, by rationalising prescriptions, enhancing therapeutic choices and reducing and preventing medication errors...

Clinical activities that contributed to the effectiveness of a cardiologist-pharmacist collaborative care model in managing diabetes.

The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). Improvements in HbA1c were associated with the provision of health education and medication adjustments.

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.

Acceptability of a cross-sectoral hospital pharmacist intervention for patients in transition between hospital and general practice: a mixed methods study.

Drug-related problems (DRPs) are often seen when a patient is transitioning from one healthcare sector to another, for example, when a patient moves from the hospital to a General Practice (GP) setting. This transition creates an opportunity for information on medication changes and follow-up plans to be lost. A cross-sectoral hospital pharmacist intervention was developed and pilot-tested in a large GP clinic. The intervention included medication history, medication reconciliation, medication review, follow-up telephone calls, identification of possible DRPs and communication with the GP. It is unknown whether the intervention is transferable to other GP clinics. The aim of the study was to explore similarities and differences between GP clinics in descriptive data and intervention acceptability. A convergent mixed methods study design was used. The intervention was tested in four GP clinics with differing characteristics. Quantitative data on the GP clinics, patients and pharmacist activities were collected. Qualitative data on the acceptability were collected through focus group interviews with general practitioners, nurses and pharmacists. The Theoretical Framework of Acceptability was used. Overall, the intervention was found acceptable and relevant by all. There were differences between the GP clinics in terms of size, daily physician work form and their use of pharmacists for ad hoc tasks. There were similarities in patient characteristics across GP clinics. Therefore, the intervention was found equally relevant for all of the clinics. Shared employment with unique access to health records in both sectors was important in the identification and resolution of DRPs. Economy was a barrier for further implementation. The intervention was found acceptable and relevant by all; therefore, it was considered transferable to other GP clinics. Hospital pharmacists were perceived to be relevant healthcare professionals to be utilized in GP, in hospitals and in the cross-sectoral transition of patients.

Application of comprehensive pharmaceutical care program in identifying and addressing drug-related problems in hospitalized patients with osteoporosis

BackgroundMore information about the impacts of comprehensive pharmaceutical care program (CPCP) on the identification and resolution of drug-related problems (DRPs) is needed. This study aimed at researching the characteristics of DRPs in osteoporosis patients and evaluating the effect of CPCP in identifying and addressing DRPs.MethodsWe performed a prospective interventional study in a teaching hospital. CPCP was established and conducted to identify and resolve DRPs by a multidisciplinary team (MDT) based on the Pharmaceutical Care Network Europe (PCNE) classification V9.0. Six pharmacists and one doctor worked directly in the study. All data was obtained from electronic medical records, direct observation and visits. The statistical analyses were performed using the SPSS Statistics software version 26.0.ResultsTwo hundred nineteen patients with osteoporosis were included in the final analysis. A total of 343 DRPs were identified, with an average of 1.57 DRPs per patient. The most common DRPs identified were “treatment safety P2” (66.8%; 229/343), followed by “other P3” (21.0%; 72/343) and “treatment effectiveness, P1” (12.2%; 42/343). The primary causes of DRPs were “dose selection C3” (35.9%; 211/588), followed by “drug use process C6” (28.9%; 170/588) and “drug selection C1” (12.6%; 74/588). Seven hundred eleven interventions were proposed to address the 343 DRPs, with an average of 2.1 interventions per DRP. The acceptance rate reached 95.9, and 91.0% of these accepted interventions were fully implemented. As a result, only 30 DRPs were unsolved before discharge. Additionally, the number of drugs was found to be associated with the number of DRPs significantly (p = 0.023).ConclusionDRPs frequently occurred in hospitalized osteoporosis patients. CPCP could be an effect option to solve and reduce DRPs for osteoporosis patients and should be implemented widely to increase patient safety.

Impact of Clinical Pharmacist-Led Interventions on Drug-Related Problems Among Pediatric Cardiology Patients: First Palestinian Experience.

BackgroundDiscovery and resolution of drug-related problems (DRPs) are taken as the cornerstone in the entire pharmaceutical care process to improve patient outcomes. Very limited reports on the analysis of DRPs in pediatric cardiology have been released worldwide.ObjectiveThe aim of this study was to disclose the impact of clinical pharmacist’s interventions on DRPs among pediatric cardiology patients in Palestine.MethodsBetween January and September 2021, a prospective interventional study involving clinical pharmacist’s care was implemented in the cardiology ward of Al-Rantisy Specialized Pediatric Hospital in Gaza, Palestine. Pharmaceutical Care Network Europe model 9.1 was used to identify DRPs, causes of the problem, clinical pharmacist’s interventions, cardiologist’s acceptance, and outcomes.ResultsA total of 309 DRPs were identified in 87 patients, representing a mean of 3.55 problems per patient. The most common DRPs were “Treatment effectiveness” (50.8%) and “Treatment safety” (30.4%), while the main causes of these DRPs were “Errors in dose timing instructions” (9.4%) and “Inappropriate combination of drugs” (13.7%), respectively. Analysis revealed that 96.7% of the interventions suggested by the clinical pharmacist were accepted by cardiologists and that 92.1% of problems were fully resolved with improved patient outcomes.ConclusionInterventions offered by the clinical pharmacist successfully addressed DRPs and positively impacted treatment outcomes in pediatric cardiology patients. With the high acceptance of pediatric cardiologists to the clinical pharmacist’s experience in Palestine, there is a growing need to integrate clinical pharmacists into cardiology teamwork care to optimize drug therapy and patient safety.

Clinical Pharmacist Intervention on Drug-Related Problems among Elderly Patients Admitted to Medical Wards of Northwest Ethiopia Comprehensive Specialized Hospitals: A Multicenter Prospective, Observational Study.

Background: Drug therapy in the elderly needs an emphasis on age-related changes in drug pharmacokinetics and pharmacodynamics profile. Hospitalized elderly patients are at risk of more than one disease and polypharmacy associated with these; they are at risk of drug-related problems. This study aimed to assess the role of clinical pharmacy on identifying and resolution of drug-related problems among elderly patients admitted to medical ward of Northwest Ethiopia comprehensive specialized hospitals. Methods: A multicenter prospective observational study was conducted. A systematic sampling technique was used. The identified drug-related problem was recorded and classified using Cipolle, and adverse drug reaction was assessed using Naranjo algorithm of adverse drug reaction probability scale, and Medscape was used for drug-drug interaction. Data were analyzed by using STATA software version 14.1. Logistic regression was used, and results were reported as odds ratios (ORs) with 95% Confidence intervals with P value < 0.05 statistically significant. Result: A total of 389 study participants were included in the study. About 266 (68.4%) of the participants had at least a single drug-related problem. About 503 drug-related problems were identified with a mean of 1.32 (CI: 1.27-1.36) drug-related problem per patient. The three-leading categories of drug-related problems were dose too high 108 (21.5%), nonadherence 105 (20.9%), and adverse drug reaction 96 (19.1%). Alcohol use (AOR = 2.2, 95CI%: 1.23-3.94), source of the drug (AOR = 2.85, 95CI%: 1.63-4.98), length of hospitalization (AOR = 2.32, 95CI%: 1.37-3.95), number of comorbidities (AOR = 1.48, 95CI%: 1.09-1.99), and polypharmacy (AOR = 3.06, 95CI%: 1.72-5.46) were important risk factors for drug-related problems. From the intervention provided, 84.7% were accepted by prescribers. Among the total drug-related problems 67.4% of the problem was totally solved. Conclusion: This study revealed that DRPs were high among elderly patients admitted to medical ward of Northwest Ethiopia. Comorbidity, length of hospitalization, ploy-pharmacy, payer, and alcohol drinker were more likely to developed drug-related problems. Treatment optimizations were also done by clinical pharmacists and interventions were well accepted by prescribers.

Frequency and prevalence of drug therapy related problems after hospitalization

Background: Drug-related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Drug-related problems (DRP) are “an event or circumstance involving drug therapy that actually or potentially interferes with the desired health outcome”. Pharmacists influence health care outcomes through the identification and resolution of drug related problems (DRPs). &#x0D; Aim and objectives: The study is aimed to assess the frequency and prevalence of drug therapy related problems in patients after hospitalization in Jayabharath Hospital, Nellore. To estimate the opportunities for pharmacist to provide pharmaceutical care. A probabilistic convenient sampling was done to estimate the frequency and prevalence of drug therapy related problems, patients those who are aged above 18 years of either sex were included. Pregnant patients, and those who are having a unwillingness to participate in study were excluded. &#x0D; Methodology: This cross sectional study was conducted between December 2020 to May 2021 on patients who discharged to home from Jayabharath Hospital, Nellore . . Most of our study population were within the age group of 30 to 45years (33.33 %) followed by 60 to 75years (25.00 %).among the present study population most of them were married (83.3 %) and illiterates (62.5 %).&#x0D; Results and Discussion: Nearly 50 drugs are responsible for drug related problems in the present study among those Phenytoin was found to be leading drug in relation to development of drug therapy related problems, Where as Nifedipine was found to be least problem producing drug in present study population.&#x0D; Conclusion: Overall we found various kinds of drug therapy related problems, which implies there is a need of continuity of care even after discharge from the hospital.

Role of clinical pharmacist in identification and resolution of drug-related problems in hemodialysis patients

Role of clinical pharmacist in identification and resolution of drug-related problems in hemodialysis patients

Detection and resolution of drug-related problems at hospital discharge focusing on information availability – a retrospective analysis

BackgroundHospital stays are often associated with medication changes, which may lead to drug-related problems (DRPs). Medication reconciliation and medication reviews are strategies to detect and resolve DRPs. MethodsA descriptive cohort study was conducted using DRPs collected during routine pharmacist-led medication reconciliation and medication reviews in the hospital's community pharmacy at discharge (Zug Cantonal Hospital, Switzerland). In a simulation experiment, we retrospectively analysed the detection and resolution possibilities of these DRPs and their dependency on different information sources. ResultsOverall, 6,087 prescriptions were filled in the hospital's community pharmacy (between June 2016 and May 2019). Among 1,352 prescriptions (with ≥ 1 documented DRP) a total of 1,876 DRPs were detected. The retrospective assessment showed that 1,115 DRPs could have been detected by performing simple medication reviews (based on the discharge prescription and the medication history), whereas in the remaining cases, additional clinical and/or patient-specific information would have been needed. In 944 (84.7 %) DRPs, which are detectable by simple medication reviews, the pharmacist would need to consult the prescriber for resolution. ConclusionThe detection of DRPs is strongly influenced by the information available. These results support models with pre-discharge medication reconciliation and pharmacist-led medication review procedures enabling both comprehensive detection and facilitated resolution of DRPs.

A cost\u2013benefit analysis of hospital-wide medication reviews: a period prevalence study

Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.

Clinical pharmacist as a member of the multidisciplinary kidney care team in low‐ and middle‐income countries: An opportunity to reduce the incidence of drug‐related problems

AbstractThe multiple comorbidities, complications, and polypharmacy coupled with pharmacokinetic and pharmacodynamics changes linked to chronic kidney disease (CKD) predispose patients with this disease to a huge number of drug‐related problems (DRPs). Evidence has shown that a clinical pharmacist (CP) is an integral member of the multidisciplinary kidney care team in most high‐income countries (HICs). In the team, CP provides patient‐centered care, including detection, prevention, and resolution of DRPs, and helping patients overcome challenges to improve drug adherence. Pharmaceutical care in CKD has demonstrated positive economic, clinical, and humanistic outcomes including reduced DRPs, all‐cause hospital admission, length of hospital stays, the incidence of end‐stage renal disease, and mortality, improved drug knowledge, adherence, health‐related quality of life among others. The purpose of this article is to highlight the gaps in drug‐related care for patients with CKD in low‐ and middle‐income countries (LMICs), demonstrate that clinical pharmacy services have the capacity to reduce these gaps, identify barriers that hinder its implementation in LMICs and offer recommendations capable of mitigating the identified barriers.

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.

Evaluation of pharmacists' interventions on drug-related problems and drug costs in patients with cancer pain.

Drug-related problems (DRPs) prevent patients from fully benefiting from drug treatment. Unrelieved pain in patients with cancer is still widespread. Pharmacists can play a role in closely monitoring cancer patients, pain control maintenance, and patient consultation. To evaluate the clinical effects and changes in drug costs of pharmacists' interventions on patients with DRPs related to cancer pain. An academic teaching hospital in Shanghai, China. Patients with cancer pain admitted to Shanghai Tongren Hospital from October 2018 to February 2019 were randomized into the intervention and control groups. The Pharmaceutical Care Network Europe classification V8.02 was used to categorize DRPs treated with analgesics. Patients' pain relief, the occurrence of adverse drug reactions, and drug cost-saving through the resolution of DRPs were evaluated. Problems and causes of drug-related problems, interventions proposed, and outcome of pharmacy recommendations. A total of 172 patients were enrolled and randomized into the intervention group (n = 86) and the control group (n = 86). The pharmacist detected 66 DRPs in 48 patients (55.8%) of the intervention group, an average of 0.8 DRPs per patient. A total of 149 interventions were proposed by the pharmacist. Compared to the control group, the drug intervention produced more pain relief on the third day of analgesic treatment. In the intervention group, a total of 33 DRP interventions resulted in cost changes, saving a drug cost of $489.90, averaging $11.94 per intervention. Our study suggests that pharmacy service in patients with cancer pain can resolve drug-related problems and reduce drug costs.

Cuidado farmacêutico: atuação e contribuição do farmacêutico no SUS, Sinop - MT

Pharmaceutical care for SUS users can contribute both to quality of life and to the correct pharmacotherapy oh the user so that they do not abandon treatment. The care aims to change the focus from the medication to the person, being then a practice oriented to the prevention, identification and resolution of Drug-Related Problems (DRPs) to improve people's health. The purpose of this study was to provide pharmaceutical care, with pharmaceutical consultations using a standardized form for the analysis of service indicators.The instruments were applied to 104 participants and were followed up using this form during the pharmaceutical consultation, performing an individual analysis of each user. Considering the users who took part in the study, 68 were diabetic, 75 were hypertensive, and 47 participants had these two associated diseases. The correlation between hypertension and the risk factors - smoking and lipemic disorders - were also evaluated. It was observed that 72 users had drug-related problems and only 32 did not have drug-related problems. The most prevalent drug-related problem was the one that relates participant’s administration and non-adherence to treatment. In view of the drug-related problems found during pharmaceutical consultations and the health conditions presented by the participants, interventions were proposed, with positive returns both in pharmacotherapy, in eating habits and in the control of parameters (blood pressure and capillary glycemia) of users, which consequently generates improvement in quality of life due to better adherence to treatment

Drug-Related Problems and Their Predictors Among Patients with Diabetes Attending the Ambulatory Clinic of Gebre Tsadik Shawo General Hospital, Southwest Ethiopia.

BackgroundPatients with diabetes are vulnerable to experiencing drug-related problems. Thus, this study aimed to assess drug-related problems and their predictors among patients with diabetes attending the ambulatory clinic of Gebre Tsadik Shawo General Hospital.MethodsA cross-sectional study was conducted from September 1, 2019 to November 30, 2019. Drug-related problems were identified using the Pharmaceutical Care Network Europe version 5.01. Patient’s written informed consent was obtained after explaining the purpose of the study. The data were collected using structured questionnaires and entered into Epi data version 4.0.2. Then, it was exported to SPSS version 21.0 for analysis. To identify predictors of the occurrence of drug-related problems, multiple stepwise backward logistic regression analysis was done. For the accuracy of data analysis, a 95% confidence interval was used, and statistical significance was considered at p-values <0.05.ResultsFrom a total of 141 patients with diabetes included in the study, 58.2% of them had at least one drug-related problem during the 3-month study period. A total of 156 drug-related problems were identified in 141 patients. Drug interactions (30.76%) and drug choice problems (25%) were the most common type of drug-related problems identified. Presence of disease comorbidity (AOR=4.12, 95% CI=1.71–9.91), poly-pharmacy (AOR=6.27, 95% CI=1.67–23.52) and more than 5 years diabetes duration (AOR=3.89, 95% CI=1.52–9.95) were independent predictors of drug-related problems.ConclusionDrug-related problems were high among patients with diabetes in the study setting. Early detection of drug-related problems ensures the appropriateness of drug therapy. Therefore, a sustainable pharmaceutical care service is needed for early identification, prevention and resolution of drug-related problems.

Identification and Resolution of Drug-Related Problems among Childhood Cancer Patients in Ethiopia.

Background Even though medications play a major role in the cure, palliation, and inhibition of disease, they also expose patients to drug-related problems. Drug-related problems are frequent and may result in reduced quality of life, morbidity, and mortality. Objectives The study was aimed to identify, characterize, and resolve drug-related problems in the Pediatric Hematology/Oncology ward of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods A prospective observational study was conducted from 25 June to 25 October 2018 to assess DRPs on patients admitted at the pediatric hematology/oncology ward of Tikur Anbessa Specialized Hospital, which is the highest level governmental tertiary care hospital in Ethiopia. Data were obtained from patients' medical charts, physicians, patients/caregivers, pharmacists, and nurses. All the collected data were entered and analyzed using the Statistical Package for the Social Sciences version 25e. Descriptive statistics were used to represent the data. Results Among the total 156 participants, DRPs were identified in 68.6% of the study subjects. Dosing problems which include dosage too low and high were the top ranking (39.3%) of all DRPs followed by needs additional therapy (27.2%) and nonadherence (14.0%). Systemic anti-infectives were the most common class of drugs involved in DRPs. Trimethoprim-sulfamethoxazole, methotrexate, vincristine, ondansetron, and metoclopramide were frequently involved in DRPs. The addition of drugs and change in drug dose were the two most proposed intervention types. Among the proposed interventions, 223 (92.15%) were fully accepted, 9 (3.72%) partially accepted, and 10 (4.13%) not accepted. Conclusion DRPs are common among Pediatric Hematology/Oncology ward patients. The hospital should develop a pediatric dosing chart for the commonly prescribed medications to prevent drug-related morbidity and mortality. The integration of clinical pharmacists can mitigate risks associated with DRPs.

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

This multicenter quality improvement initiative aims to measure and quantify pharmacists' impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists' value in transitions of care and assist in expanding pharmacist services.

Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation

BackgroundPharmaceutical care services have been recognized as the most highly regarded professional pharmacy practice model that allows the identification, intervention, and resolution of drug related problems. This practice provides significant clinical outcomes and can reduce direct and indirect costs for health systems. However, its implementation can be complex and challenging, needing study experiences that aims at overcoming obstacles, especially in free and universal healthcare systems. The objective of this study is to evaluate the implementation of Ambulatory Care Pharmacy services for older adults at Paulista Institute of Geriatrics and Gerontology (IPGG), which is recognized in the city of São Paulo for offering pharmaceutical care services for over 10 years continuously. This initiative and process is independent of external academic interventions or educational institutions. It is hoped that the results may also contribute to advancing the implementation of pharmaceutical care service in similar health systems.DesignThis is a case study using multiple sources of data. Qualitative and quantitative data were collected from institutional documents, by participant observation and interviews. Initial themes were identified by content analysis and analyzed under the context-mechanism-outcome configurations (CMO Configurations) in realistic evaluation.SettingGeriatrics and Gerontology Institute of São Paulo (known as IPGG).ParticipantsEleven health professionals and three pharmaceutical care service users.ResultsThree CMO configurations were identified and accepted: “Scenario Construction mediated by educational processes”, “Contribution to complex needs resolution”, and “Organizational Visibility”. The CMO (Context-Mechanism-Outcomes) configuration “Logistic activities discourage clinical pharmaceutical services implantation” was denied due to the influence of accepted CMOs.ConclusionsEducational processes which value transdisciplinary knowledge exchanges provide resources required to overcome important obstacles present during pharmaceutical care implementation. Thus, providing and seeking knowledge to build and offer context-consistent clinical health services as well as fulfilling organizational environment requirements can be the key to implement pharmaceutical care service.