International Journal of Clinical Pharmacy

, Volume 35, Issue 2, pp 202–209 | Cite as

A retrospective analysis of drug-related problems documented in a national database

  • Tommy WesterlundEmail author
  • Ulrika Gelin
  • Elisabeth Pettersson
  • Fredrik Skärlund
  • Kajsa Wågström
  • Carina Ringbom
Research Article


Background Numerous patients are subject to drug-related problems (DRPs) every day, resulting in sub-optimal therapy, suffering and decreased quality of life, as well as in high societal health care costs. Classifying DRPs is important for the development of counselling skills and for pharmaceutical care practice and research, including assessments of the value of pharmacists’ clinical interventions. Pharmacy practitioners have also reported to become more attentive to patients’ drug-related needs, when requested to document their clinical interventions. Several studies have been conducted on DRPs, but there is still a need for a more thorough knowledge about their nature and the reasons for their occurrence. To examine DRP characteristics and causes by retrospectively analysing data and patient case histories, as documented by pharmacy practitioners in the Swedish national DRP database. Setting Community pharmacy based patient documentation, entered into the Swedish national DRP database. Method Documented DRPs, clinical interventions and patient data were retrospectively examined and analysed. Particular attention was paid to case history reports in free text fields. Only reports containing adequate information for analysis and actual, correctly categorised DRPs were included. Main outcome measure Subdivided DRP characteristics and causes. Results Both similarities and differences between DRP subclasses of prescription patients (n = 5,571) and OTC drug consumers (n = 2,894) were observed. Most DRP categories could be subdivided into at least three subclasses, according to their characteristics. Causes of DRPs could be extracted from free text field reports in four prescription DRP categories and three OTC DRP categories. Uncertainty about the aim of the drug was commonly characterised by a lack of knowledge about the indication in prescription patients and in an inappropriate drug selection in OTC drug consumers. A switch from a brand-name drug to a generic drug or from one generic to another was the cause in half of the therapy failures, which in turn was a frequent reason for overuse of drug. Conclusion The study demonstrates the multi-facetted drug-related problems in patients and confirms the importance of attention by pharmacy practitioners for the detection of and intervention for DRPs.


Clinical interventions Community pharmacy Drug-related problems Pharmaceutical care Sweden 



The study was funded by Apoteket AB.

Conflict of interest



  1. 1.
    van Mil JWF, Westerlund LOT, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38:859–67.PubMedCrossRefGoogle Scholar
  2. 2.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: meta-analysis of prospective studies. JAMA. 1998;279:1200–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Pouyanne P, Haramburu F, Imbs JL. Be′gaud B. Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. Br Med J. 2000;320:1036.CrossRefGoogle Scholar
  4. 4.
    Winterstein AG, Sauer BC, Hepler CD, Poole C. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36:1238–48.PubMedCrossRefGoogle Scholar
  5. 5.
    Beijer HJM, De Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a metaanalysis of observational studies. Pharm World Sci. 2002;24:46–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Fryckstedt J, Asker-Hagelberg C. Läkemedelsrelaterade problem vanliga på medicinakuten [Drug-related problems common at the medical emergency ward]. Swedish Läkartidningen. 2008;105:894–8.Google Scholar
  7. 7.
    McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36:1331–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Lobo BL, Reinke DW, Swearingen LL. Medication-related problems: a common cause of hospital readmission. AACP and ESCP International Congress on Clinical Pharmacy. Documenting the value of clinical pharmacy services, Orlando, 1999; Poster 200E. Pharmacotherapy 1999; 19:510.Google Scholar
  9. 9.
    Smith DL. The effect of patient non-compliance on health care costs. Med Interface 1993; 6(4):74–76, 78, 84.Google Scholar
  10. 10.
    Guignard AP, Couray-Targe S, Colin C, Chamba G. Economic impact of pharmacists’ interventions with nonsteroidal anti-inflammatory drugs. Ann Pharmacother. 2003;37:332–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Strand LM, Cipolle RJ, Morley PC, Frakes MJ. The impact of pharmaceutical care practice on the practitioner and the patient in the ambulatory practice setting: twenty- five years of experience. Curr Pharm Des. 2004;10:3987–4001.PubMedCrossRefGoogle Scholar
  12. 12.
    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 randomized trial of the effect of education and a professional allowance. Pharmacoeconomics. 2000;18:459–68.PubMedCrossRefGoogle Scholar
  13. 13.
    Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34:319–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Westerlund LOT, Handl WHA, Marklund BRG, Allebeck P. Pharmacy practitioners’ views on computerized documentation of drug-related problems. Ann Pharmacother. 2003;37:354–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Westerlund T. Kunders/patienters läkemedelsrelaterade problem [Customers’/patients’ drug-related problems] in Från förskrivning till användning—Farmacevtens roll för en bättre läkemedelsanvändning [From prescribing to use—the pharmacist’s role for an improved drug use], p.133. Swedish. Carlsten A, Castensson S (editors). ISBN 978-91- 976510-8-0. Apotekarsocieten, Stockholm, 2011.Google Scholar
  16. 16.
    Apoteket AB. Statistics. Stockholm: National DRP database; 2010.Google Scholar
  17. 17.
    WHO. The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD) Accessed 25 July 2012.
  18. 18.
    Westerlund T, Almarsdóttir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7:40–50.CrossRefGoogle Scholar
  19. 19.
    Ax F, Brånstad J-O, Westerlund T. Pharmacy counselling models—a means to improve patient drug use. J Clin Pharm Ther. 2010;35:439–51.PubMedGoogle Scholar
  20. 20.
    Hämmerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41:1825–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Williams M, Peterson GM, Tenni PC, Bindoff IK, Curtain C, Hughes J, et al. Drug-related problems detected in Australian community pharmacies: the PROMISe Trial. Ann Pharmacother. 2011;45:1067–76.PubMedCrossRefGoogle Scholar
  22. 22.
    Pharmaceutical Care Network Europe (PCNE). Classification for Drug related problems (revised 14-01-2010vm) V6.2. Accessed 4 July 2012.
  23. 23.
    Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Krähenbühl JM, kremer B, Guignard B, Bugnon O. Practical evaluation of the drug- related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30:777–86.PubMedCrossRefGoogle Scholar
  25. 25.
    Eickhoff C, Hämmerlein A, Griese N, Schulz M. Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol Drug Saf. 2012;21:254–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Jazairi AS, Bhareth S, Eqtefan IS, Al-Suwayeh SA. Brand and generic medications: are they interchangeable? Ann Saudi Med. 2008;28(1):33–41. Review.PubMedCrossRefGoogle Scholar
  27. 27.
    Heller FR, Dupont AG. Generics: need for clinical concern? Acta Clin Belg. 2009;64:415–22.PubMedGoogle Scholar
  28. 28.
    Hellström J, Rudholm N. Side effects of generic competition? Eur J Health Econ. 2004;5(3):203–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Johnston A, Stafylas P, Stergiou GS. Effectiveness, safety and cost of drug substitution in hypertension. Br J Clin Pharmacol. 2010;70(3):320–34.PubMedCrossRefGoogle Scholar
  30. 30.
    Duerden MG, Hughes DA. Generic and therapeutic substitutions in the UK: are they a good thing? Br J Clin Pharmacol. 2010;70(3):335–41.PubMedCrossRefGoogle Scholar
  31. 31.
    Regeringskansliet. Nationell läkemedelsstrategi.[Government Offices of Sweden. National medicine strategy] Swedish. Stockholm. (2011). Accessed 28 Feb 2012.
  32. 32.
    FIP. Good Pharmacy Practice. Joint FIP/WHO Guidelines on GPP: Standards for quality of pharmacy services. The Hague. (2011). Accessed 4 July 2012.
  33. 33.
    Apotekarsocieteten och Sveriges Apoteksförening. God apotekssed i Sverige (GPP). [Good Pharmacy Practice in Sweden] Swedish. Accessed 28 Feb 2012.

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Tommy Westerlund
    • 1
    • 2
    Email author
  • Ulrika Gelin
    • 3
  • Elisabeth Pettersson
    • 4
  • Fredrik Skärlund
    • 5
  • Kajsa Wågström
    • 6
  • Carina Ringbom
    • 7
  1. 1.Social Pharmacy, Department of Rational Use of MedicinesMedical Products AgencyUppsalaSweden
  2. 2.Social Medicine, Department of Public Health and Community Medicine, Institute of MedicineThe Sahlgrenska Academy at the University of GothenburgGöteborgSweden
  3. 3.Apotek HjärtatUppsalaSweden
  4. 4.Apoteket ÖrnenApoteket ABTierpSweden
  5. 5.Apotek HjärtatMellerudSweden
  6. 6.Apoteket FarmaciFalu LasarettFalunSweden
  7. 7.Apoteket ABStockholmSweden

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