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Pharmacy World & Science

, Volume 32, Issue 4, pp 512–519 | Cite as

Relationship between drug-related problems and health outcomes: a cross-sectional study among cardiovascular patients

  • Anne NiquilleEmail author
  • Olivier BugnonEmail author
Research article

Abstract

Objective To describe drug-related problems (DRPs) and expense problems (EPs) identified by a standardised community pharmacist-based medication review (MR) program among Swiss cardiovascular outpatients (56–75 years old) and to evaluate the need for collaborative pharmacy practice to achieve economic, clinical and humanistic outcomes. Setting A pilot population of 85 cardiovascular outpatients who were customers of 14 community pharmacies (members of the pharmacieplus virtual chain) and insured with Groupe Mutuel health insurance. Method Cross-sectional study of a structured medication review program, conducted by 11 pharmacists in collaboration with 61 general practitioners (GPs), with patient interviews and access to medical data. Main outcome measure Numbers and types of DRPs and EPs within the study population and odds ratios between them, as well as economic, clinical and humanistic outcomes. Results Of the included patients, 91% had at least one DRP or EP. The odds ratios indicated that not being exposed to DRPs was associated with a higher chance of reaching the clinical target (OR: 3.4; IC95%:1.1–10.5; P = 0.01), of having a better physical quality of life than the median (OR: 2.5; IC95%:0.9–7.3; P = 0.05) and having lower total health care costs (OR: 3.2; IC95%:1.1–9.8; P = 0.02). Conclusions This cross-sectional study shows that the control of cardiovascular risk factors, quality of life and healthcare costs are statistically related to the presence of DRPs detected by a community pharmacist-based MR program.

Keywords

Collaborative pharmacy practice Community pharmacy Drug costs Drug-related problems Medication review Quality of life Switzerland 

Notes

Acknowledgments

We are grateful to the voluntary participating community pharmacists and GPs; to Prof. Rob Horn for letting us use the MARS-5© and to J.-M. Krähenbühl and the virtual chain pharmacieplus for supporting this university research in community pharmacy practice.

Funding

This pilot study was funded by the virtual chain of independent pharmacists pharmacieplus.

Conflict of interests

None to declare.

References

  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  2. 2.
    van Mil JW, Schulz M, Tromp TF. Pharmaceutical care, European developments in concepts, implementation, teaching, and research: a review. Pharm World Sci. 2004;26:303–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41:1569–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41:1770–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008;42:1195–207.CrossRefPubMedGoogle Scholar
  6. 6.
    Ponniah A, Anderson B, Shakib S, Doecke CJ, Angley M. Pharmacists’ role in the post-discharge management of patients with heart failure: a literature review. J Clin Pharm Ther. 2007;32:343–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168:687–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health. 2003;25:144–53.CrossRefGoogle Scholar
  9. 9.
    Wubben DP, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy. 2008;28:421–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2:3–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care. 2006;15:23–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102:275–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol. 2008;65:303–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. BMJ. 2004;329:15–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Schneeweiss S, Hasford J, Gottler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol. 2002;58:285–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;11:65–72.CrossRefPubMedGoogle Scholar
  17. 17.
    Wester K, Jonsson AK, Spigset O, Druid H, Hagg S. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol. 2008;65:573–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedGoogle Scholar
  19. 19.
    Krahenbuhl JM, Decollogny A, Bugnon O. Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program. Pharm World Sci. 2008;30(6):816–22.CrossRefPubMedGoogle Scholar
  20. 20.
    Horne R, Clatworthy J, Polmear A, Weinman J. Do hypertensive patients’ beliefs about their illness and treatment influence medication adherence and quality of life? J Hum Hypertens. 2001;15(Suppl 1):S65–8.PubMedGoogle Scholar
  21. 21.
    Ware JE, Kosinski M, Turner-Bowker DM, Ganiats TG. How to score version 2 to the SF-12 health survey. Lincoln, RI: QualityMetric Inc.;2005. ISBN 1-897810-10-3.Google Scholar
  22. 22.
    The Pharmaceutical Care Network Europe Classification V6.2 (document on the Internet). 2010. http://www.pcne.org/Documents/DRP/PCNE%20classification%20V6-2.pdf. Updated 14 Jan 2010, accessed 10 Mar 2010.
  23. 23.
    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;2:195–205.Google Scholar
  24. 24.
    Fernandez-Llimos F, Faus MJ. Comment: drug-related problem classification systems. Ann Pharmacother. 2004;38:1542–3.PubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    Niquille A, Lattmann C, Bugnon O. Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators. Pharm Pract (Internet). 2010;8(1):35–42.Google Scholar
  27. 27.
    Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S, et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med. 2006;144:475–84.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.School of pharmaceutical sciencesUniversity of Geneva, University of Lausanne, Community Pharmacy, Pharmacie de la PMULausanneSwitzerland
  2. 2.Ambulatory Care and Community Medicine Department (PMU-Lausanne), Community Pharmacy Practice UnitPharmacie de la PMULausanneSwitzerland

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