Practical evaluation of the drug-related problem management process in Swiss community pharmacies
- 445 Downloads
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.
KeywordsCoding system Community pharmacy DRP-classification Drug-related problems Pharmaceutical care Prescribing Quality of care Switzerland
We would like to thank the pharmacists from the 20 participating pharmacies.
pharmaSuisse, the Swiss Association of Pharmacists, funded this Ph.D. student research.
Conflicts of Interest
- 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
- 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.
- 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.
- 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
- 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
- 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
- 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