Prevalence and safety‐relevance of drug‐related problems in German community pharmacies

Lewinski, Daniel; Wind, Stefan; Belgardt, C; Plate, Vanessa; Behles, Christian; Schweim, Harald G.

doi:10.1002/pds.1861

Cited by 24 publications

(29 citation statements)

References 37 publications

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“…A broad range of studies, mainly in the area of prescription-only medicines, supports this fact [5][6][7][8][9] . A DRP has been defined by Hepler and Strand as: "A drug-related problem is an event or circumstance involving drug treatment that actually or potentially interferes with the patient's experiencing an optimum outcome of medical care".…”

Section: Introductionmentioning

confidence: 97%

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Prevalence of drug-related problems in self-medication in Danish community pharmacies

Frøkjær¹,

Bolvig²,

Griese³

et al. 2012

Innov Pharm

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Section: Introductionmentioning

confidence: 97%

“…Pharmaceutical counselling is an important instrument for assuring treatment appropriateness and safety of OTC drugs, and it is recommended to introduce quality assurance for counselling 9 .…”

Section: Innovations In Pharmacymentioning

confidence: 99%

Prevalence of drug-related problems in self-medication in Danish community pharmacies

Frøkjær¹,

Bolvig²,

Griese³

et al. 2012

Innov Pharm

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“…an infant care and educational establishment, 133 local community setting, 185,186 general practice and emergency department, 37 outpatient population seeking medical care 187 and after discharge from hospital. 45 …”

Section: Systematic Review Of Paediatric Adverse Drug Reactionsmentioning

confidence: 99%

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

Smyth

Peak

Turner

et al. 2014

Programme Grants for Applied Research

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AimsTo comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication.Review methodsTwo prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs.ResultsThe estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02;p < 0.001]. When medicines used for the treatment of oncology patients were excluded, OLUL medicines were not more likely to be implicated in an ADR than authorised medicines (RR 1.03, 95% CI 0.72 to 1.48;p = 0.830). For children who had been in hospital for > 48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59;p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents.ConclusionThe Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Unjustified and inappropriate self-medication results in wastage of healthcare resources and increases resistance of pathogens, drug-drug interactions, and adverse drug reactions leading to hospital admissions [12,13,14,15]. Most of the studies on self-medication in children have investigated the use of medicines by children themselves [16,17].…”

Section: Discussion:-mentioning

confidence: 99%

“…This practice is widespread around the world (1) .The practice of self-medication among children consider really important since they constitute a large percentage of the population in developing countries and are prone to many illnesses (2) . Unjustified and inappropriate self-medication results in wastage of healthcare resources and increases resistance of pathogens, drugdrug interactions, and adverse drug reactions leading to hospital admissions (3)(4)(5)(6). Younger children are often given medications by their parents because the first response by most families to many illnesses in their children has been found to be the use of non-prescribed drugs.…”

mentioning

confidence: 99%

Prevalence of Parental Self Medication and Its Possible Effect to Their Children in Al-Madinah , Kingdom of Saudi Arabia.

Alkhayat.¹,

Albouq.²,

Osailan³

et al. 2017

IJAR

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Prevalence and safety‐relevance of drug‐related problems in German community pharmacies

Cited by 24 publications

References 37 publications

Prevalence of drug-related problems in self-medication in Danish community pharmacies

Prevalence of drug-related problems in self-medication in Danish community pharmacies

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

Prevalence of Parental Self Medication and Its Possible Effect to Their Children in Al-Madinah , Kingdom of Saudi Arabia.

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