These data illustrate the prevalence of drug-related problems and the ability of pharmacists to identify these problems in the Australian models of medication review. The nature and frequency of problems varied between reviews for home-dwelling and care-facility patients. Such information may be used to better focus the training of practitioners based on the most frequently encountered health problems and the nature of common drug-related problems in the two settings.

Background Disagreement among healthcare professionals on the clinical relevance of drug-related problems can lead to suboptimal treatment and increased healthcare costs. Elderly patients with chronic non-cancer pain and comorbidity are at increased risk of drug related problems compared to other patient groups due to complex medication regimes and transition of care. Objective To investigate the agreement among healthcare professionals on their classification of clinical relevance of drug-related problems in elderly patients with chronic non-cancer pain and comorbidity. Setting Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark. Method A pharmacist performed medication review on elderly patients with chronic non-cancer pain and comorbidity, identified their drug-related problems and classified these problems in accordance with an existing categorization system. A five-member clinical panel rated the drug-related problems' clinical relevance in accordance with a five-level rating scale, and their agreement was compared using Fleiss' κ. Main outcome measure Healthcare professionals' agreement on clinical relevance of drug related problems, using Fleiss' κ. Results Thirty patients were included in the study. A total of 162 drug related problems were identified, out of which 54% were of lower clinical relevance (level 0-2) and 46% of higher clinical relevance (level 3-4). Only slight agreement (κ = 0.12) was found between the panellists' classifications of clinical relevance using a five-level rating scale. Conclusion The clinical pharmacist identified drug related problems of lower and higher clinical relevance. Poor overall agreement on the severity of the drug related problems was found among the panelists.

Background Patients have medicines reviews conducted by different health care professionals in different settings. Introducing a clinical panel to drug related problems (DRPs) to evaluate their clinical significance is common practice. The clinical panel discuss the potential consequences and come to a mutual agreement on the level of clinical significance. However, to what degree does the panel agree? Purpose To compare the agreement between different health care professionals who have evaluated the clinical significance of DRPs. Materials and methods DRPs were identified in 30 comprehensive medicines reviews conducted by a clinical pharmacist. Two hospital pharmacists, a general practitioner and two specialists in pain management from hospital care (the Panel) evaluated each DRP considering the potential clinical outcome for the patient. The DRPs were rated either nil, low, minor, moderate or highly clinically significant. Agreement was analysed using Kappa statistics. A Kappa value of 0.8 to 1.0 indicated nearly perfect agreement between ratings of the Panel members. Results The Panel rated 45 percent of the total 162 DRPs as of moderate clinical significance. However, the overall kappa score was 0.12 showing nil agreement when comparing the ratings of clinical significance. The Panel disagreed on which DRPs were of minor or moderate clinical significance. Further analysis of the interrelationship of the five Panel members described fair agreement between one specialist and the two pharmacists. In two types of DRPs, sub-therapeutic dosing and side effects, the Panel agreed fairly well on moderate clinical significance. Conclusions Each profession rates the clinical significance of DRPs differently, especially in cases of intervention by pharmacist versus practitioner, and opinion also varies within each profession. Take into account the profession and setting when clinical relevance of DRPs is discussed in the literature and when choosing a method for evaluating the clinical significance of DRPs. Acknowledgement Many thanks to Grünenthalfonden and Actavisfonden, participants in the project ‘Drug Related Problems in the Frontier between Primary and Secondary Health Care’. No conflict of interest.