Advertisement

Pharmacy World & Science

, Volume 30, Issue 6, pp 777–786 | Cite as

Practical evaluation of the drug-related problem management process in Swiss community pharmacies

  • Jean-Marc Krähenbühl
  • Bertha Kremer
  • Bertrand Guignard
  • Olivier BugnonEmail author
Research Article

Abstract

Objective To develop and evaluate a coding system integrated into pharmaceutical software to routinely report and assess the process of community pharmacists’ interventions related to medical prescriptions. Setting A convenient sample of 20 Swiss community pharmacies. Method Pharmacists documented their interventions concerning all drug-related problems (DRPs) related to medical prescriptions during four consecutive weeks in 2005. The coding system assesses each step of the DRP management process; that is, the type of problem, possible negative outcomes, pharmaceutical decisions, and individuals involved. In order to be comprehensive, the management process of technical problems related to prescriptions and clinical DRPs was analysed separately. Main outcome measure DRP intervention rate and characterization of each step of the process. Results Of 38,663 prescriptions, 287 clinical DRPs required interventions. This corresponds to a mean intervention rate of 0.77% per pharmacy (SD = 0.61%). There was a large variability among pharmacies (0–2.6%). Most of the clinical DRPs were associated with dosage problems (n = 91) and drug–drug interactions (n = 45). The most frequent potential negative outcomes reported were quantitative inefficacy (n = 101) and quantitative safety (n = 94). Two-thirds of clinical DRPs required a prescription modification (n = 186), the most frequent being a change in dosage or drug regimen. In 110 interventions (38%), physicians were immediately contacted to take part in the decision. In 122 interventions (43%), pharmacists managed the interventions alone. However, in 55 interventions (19%), pharmacists managed the DRPs with the patient. From these 287 clinical interventions, 134 different codes were reported. Seven hundred and thirty-six technical problems related to prescriptions required intervention, which corresponded to a mean intervention rate of 1.90% per pharmacy. The main type of problem was a discrepancy with the medication record (n = 208). There were 494 instances that required a prescription modification. Pharmacists resolved 45% of all technical problems by themselves. Conclusion The developed coding system could describe the management process for DRPs. The observed intervention rate and the frequency of steps involved were comparable to those previously observed for pharmacists’ interventions. Data regarding the entire process used to manage drug-related problems can be useful in improving medication safety, education, and collaborative care.

Keywords

Coding system Community pharmacy DRP-classification Drug-related problems Pharmaceutical care Prescribing Quality of care Switzerland 

Notes

Acknowledgements

We would like to thank the pharmacists from the 20 participating pharmacies.

Funding

pharmaSuisse, the Swiss Association of Pharmacists, funded this Ph.D. student research.

Conflicts of Interest

None

References

  1. 1.
    van Mil JF, Westerlund LT, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859–67.PubMedCrossRefGoogle Scholar
  2. 2.
    Caleo S, Benrimoj SI, Collins D, Hall J, Lauchlan R, Stewart K. Pharmacists’ clinical interventions. Aust Pharm. 1996;15(3):143–8.Google Scholar
  3. 3.
    Pickard AS, Johnson JA, Farris KB. The impact of pharmacist interventions on health-related quality of life. Ann Pharmacother. 1999;33(11):1167–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharmacol. 1999;47(6):695–700.PubMedCrossRefGoogle Scholar
  5. 5.
    Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30(10):926–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K, et al. Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance. Pharmacoeconomics. 2000;18(5):459–68.PubMedCrossRefGoogle Scholar
  7. 7.
    Smith CP, Christensen DB. Identification and clarification of drug therapy problems by Indian health service pharmacists. Ann Pharmacother. 1996;30(2):119–24.PubMedGoogle Scholar
  8. 8.
    Guignard E, Bugnon O. Pharmaceutical care in community pharmacies: practice and research in Switzerland. Ann Pharmacother. 2006;40(3):512–7.PubMedCrossRefGoogle Scholar
  9. 9.
    ISAS (International Standardization and Accreditation Services)—QMS (Quality Management System) Pharma-2010 [document on the Internet]. http://www.isas.org/data-bases/isas-qms-pharma-2010-pharmacies.html. Updated 30 Jan 2001, cited 15 Jan 2008.
  10. 10.
    Schaefer M. Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc. Pharm World Sci. 2002;24(4):120–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Schumock GT, Hutchinson RA, Bilek BA. Comparison of two systems for documenting pharmacist interventions in patient care. Am J Hosp Pharm. 1992;49(9):2211–4.PubMedGoogle Scholar
  12. 12.
    Westerlund LT, Handl WH, Marklund BR, Allebeck P. Pharmacy practitioners’ views on computerized documentation of drug-related problems. Ann Pharmacother. 2003;37(3):354–60.PubMedCrossRefGoogle Scholar
  13. 13.
    The Pharmaceutical Care Network Europe Classification V 5.00 [document on the Internet]. http://www.pcne.org/dokumenter/PCNE%20classification%20V5.00.pdf. Updated 6 Aug 2003, cited 15 Jan 2008.
  14. 14.
    Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25(2):65–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Fernandez-Llimós F, Faus M-J, Gastelurruita MA, Baena MI, Tuneu L, Martinez Martinez F. Systematic identification of negative clinical outcomes from pharmacotherapy. Seguim Farmacoter. 2004;2(3):195–205.Google Scholar
  16. 16.
    Fernandez-Llimos F, Faus MJ. Comment: drug-related problem classification systems. Ann Pharmacother. 2004;38(9):1542–3.PubMedGoogle Scholar
  17. 17.
    Knapp KK, Katzman H, Hambright JS, Albrant DH. Community pharmacist interventions in a capitated pharmacy benefit contract. Am J Health Syst Pharm. 1998;55(11):1141–5.PubMedGoogle Scholar
  18. 18.
    Westerlund LT, Almarsdottir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7:40–50.Google Scholar
  19. 19.
    Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug-related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.PubMedGoogle Scholar
  20. 20.
    Andersson AC, Brodin H, Nilsson JL. Pharmacist interventions in relation to patient drug related problems. J Soc Admin Pharm. 2003;20:82–90.Google Scholar
  21. 21.
    Hammerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41(11):1825–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Westerlund T, Almarsdottir AB, Melander A. Factors influencing the detection rate of drug-related problems in community pharmacy. Pharm World Sci. 1999;21(6):245–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Belton KJ. The European Pharmacovigilance Research Group. Attitude survey of adverse drug-reaction reporting by health care professionals across the European Union. Eur J Clin Pharmacol. 1997;52(6):423–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Currie JD, Chrischilles EA, Kuehl AK, Buser RA. Effect of a training program on community pharmacists’ detection of and intervention in drug-related problems. J Am Pharm Assoc (Wash). 1997;NS37(2):182–91.Google Scholar
  25. 25.
    von Ferber L, Bausch J, Koster I, Schubert I, Ihle P. Pharmacotherapeutic circles. Results of an 18-month peer-review prescribing-improvement programme for general practitioners. Pharmacoeconomics. 1999;16(3):273–83.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Jean-Marc Krähenbühl
    • 1
  • Bertha Kremer
    • 1
  • Bertrand Guignard
    • 1
  • Olivier Bugnon
    • 2
    Email author
  1. 1.Ambulatory Care and Community Medicine DepartmentCommunity Pharmacy UnitLausanneSwitzerland
  2. 2.Ambulatory Care and Community Medicine Department, Community Pharmacy UnitPharmaceutical Sciences Section, University of GenevaLausanneSwitzerland

Personalised recommendations