Evaluating categorisation and clinical relevance of drug-related problems in medication reviews

Abstract

Sammendrag:Objectives: we aimed to evaluate the categorisation and clinical relevance of DRPs identified by community pharmacists, and further, to assess the quality of interventions with the patients and the physicians as documented by the pharmacists. Setting 23 Norwegian community pharmacies. Method: patients with type 2 diabetes were recruited by 24 community pharmacists who performed structured medication reviews based on the patients' drug profiles and patient interviews. The DRPs identified were subsequently categorised. An evaluation group (EG) retrospectively evaluated the reviews. Clinical/practical relevance of each DRP and quality of community pharmacists' intervention with patients and physician were scored. Average agreement between the EG and the community pharmacists was calculated. Internal agreement in the EG was calculated using a modified version of Fleiss' Kappa coefficient. Results: a total of 73 patients were included (mean age 62 years, 52% female, on average prescribed 8.7 drugs). The pharmacists identified 88 DRPs in 43 of the patients. The most common DRPs were adverse drug reactions (22%) and wrong drug or dose used by patient (14%). Anti-diabetic drugs and lipid modifying drugs were associated with the most DRPs. The EG agreed with detection and categorisation of DRPs in more than 80% of the cases. The clinical/practical relevance of the detected DRPs was scored by the EG to be high or medium in 87% of the cases. The quality of the follow-up with patients and physicians was scored to be good or satisfactory in 93 and 98% of the cases, respectively. Conclusions: pre-defined categories of DRPs supported by structured forms were reliable and valid tools for identifying DRPs. The evaluation demonstrated that community pharmacists were able to identify DRPs of high to medium clinical/practical relevance, and to perform follow-ups of the DRPs with the patients and the physicians with a good or satisfactory quality.

Improving medication safety and diabetes management in Hong Kong: a multidisciplinary approach

“…9,36,37 The majority of DRPs were dosing problems (43.9%), with "drug dose too low or dosage regimen insufficient" as the largest subcategory. In contrast to the lower percentage (5.9%-21.6%) in five overseas studies, [9][10][11][12]36 our high prevalence of dosing problems was in line with a local study of medication incidents among hospital in-patients, 38 mostly arising from self-adjustment of dosage or frequency, confusion about previous dose changes and dosage modification by GPs or doctors overseas. These highlight the pivotal role of local pharmacists in conducting MR, reviewing drug dosages to ensure safety and efficacy, monitoring patients' metabolic control regularly as well as reminding patients and/or their caregivers to maintain an updated medication list and follow the latest drug label instructions.…”

“…10,11 The most common subcategory was "no drug prescribed but clear indication", such as the omission of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEI/ ARB) in patients with microalbuminuria or patient's reluctance to use insulin. Hence, pharmacists have a role in advising doctors to adhere to the latest treatment guidelines and educate patients about the treatment benefits of each drug class.…”

“…39 Drug use issues were the fourth most common category with comparable prevalence (12.0%) with a Malaysian study 9 although this ranges widely among other studies (3.8%-54.2%). 10,11,36 Reasons for the subcategory of "drug not taken/administered at all" included inability to purchase a self-financed item due to cost, ignorance of the indications, concern about side-effects, and confusion about previous regimen changes. 40 In our study, pharmacists mainly intervened by direct patient counselling, recommending reinforcement of patient compliance to doctors or suggesting changes to drug regimens.…”

“…Other categories of DRPs included "insufficient awareness of health and diseases" (such as poor dietary control) and "inappropriate timing of administration", but this category could also encompass therapy failure and inappropriate lifestyle choices, resulting in greater variation of prevalence from overseas studies (6.8%-46.6%). [9][10][11]36 Pharmacists are ideally positioned to advise patients about the importance of diet, smoking cessation, regular exercise, and SMBG. 22 The drug classes most implicated in DRPs were for the endocrine system (45.6%) followed by cardiovascular system (38.1%).…”

“…In several overseas studies, pharmacists have implemented timely interventions to resolve or prevent DRPs by offering recommendations to prescribers, with an acceptance rate of over 60%. [10][11][12][13] The positive impact of pharmacists in improving diabetes management or its co-morbidities has also been recognised by interventional and controlled observational studies worldwide.…”