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International Journal of Clinical Pharmacy

, Volume 33, Issue 6, pp 1010–1018 | Cite as

The process of identifying, solving and preventing drug related problems in the LIMM-study

  • Anna Bergkvist ChristensenEmail author
  • Linda Holmbjer
  • Patrik Midlöv
  • Peter Höglund
  • Lisa Larsson
  • Åsa Bondesson
  • Tommy Eriksson
Research Article

Abstract

Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient’s drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service. Setting Three wards at a department of internal medicine. Method Pharmacists performed systematic interventions during the patient’s hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel’s attitudes towards the process. Main outcome measure The number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel’s attitudes towards the model. Results In total, 1,227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. Conclusion The process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance.

Keywords

Clinical pharmacy service Drug related problem (DRP) Elderly Inpatients LIMM-study Medication review Pharmaceutical care Sweden 

Notes

Acknowledgments

We would like to thank the staff at the department of internal medicine at Landskrona Hospital, especially Dr Per Löfdahl, and the clinical pharmacists Sofia Jönsson and Emma Olsson for excellent cooperation and work.

Funding

We are grateful to the National Board of Health and Welfare, the Swedish Academy of Pharmaceutical Sciences, the County of Skåne and Apoteket Farmaci AB for funding the study.

Conflicts of interests

The authors declare no conflicts of interest.

References

  1. 1.
    Bergman A, Olsson J, Carlsten A, Waern M, Fastbom J. Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care. 2007;25(1):9–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Olsson J, Fastbom, J. The quality of the drug use in the elderly, the KÄLLA-project, an application of quality indicators to analyze the drug use in elderly with a medication dispensing system in nursing homes in a Swedish county (In Swedish: Kvaliteten i äldres läkemedelsanvändning KÄLLA-Projektet, en tillämpning av kvalitetsindikatorer för analys av läkemedelsanvändningen hos äldre med dosexpedition på kommunala äldreboenden i ett svenskt län) The National Board on Health and Welfare. http://www.socialstyrelsen.se/publikationer2004/2004-131-24. Accessed 12 August 2010.
  3. 3.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Einarson TR. Drug-related hospital admissions. Ann Pharmacother. 1993;27(7–8):832–40.PubMedGoogle Scholar
  5. 5.
    Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.PubMedCrossRefGoogle Scholar
  6. 6.
    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 18 820 patients. BMJ. 2004;329(7456):15–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Paul E, End-Rodrigues T, Thylen P, Bergman U. Adverse drug reactions a common cause of hospitalization of the elderly. A clinical retrospective study. Läkartidningen. 2008;105(35):2338–42.PubMedGoogle Scholar
  8. 8.
    Organization WorldHealth. Safety of medicines. Geneva: A guide to detecting and reporting adverse drug reactions; 2002.Google Scholar
  9. 9.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMedGoogle Scholar
  10. 10.
    Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24(11):1093–7.PubMedGoogle Scholar
  11. 11.
    Hepler CD. What is the relationship between clinical pharmacy and pharmaceutical care? ESCP Newsletter. 2001;105.Google Scholar
  12. 12.
    Viktil KK, Blix HS, Moger TA, Reikvam A. Interview of patients by pharmacists contributes significantly to the identification of drug-related problems (DRPs). Pharmacoepidemiol Drug Saf. 2006;15(9):667–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in United States hospitals. Pharmacotherapy. 2006;26(6):735–47.PubMedCrossRefGoogle Scholar
  15. 15.
    Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacist staffing, and drug costs in United States hospitals. Pharmacotherapy. 1999;19(12):1354–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.PubMedCrossRefGoogle Scholar
  17. 17.
    Bergkvist A, Midlov P, Hoglund P, Larsson L, Eriksson T. A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management. J Eval Clin Pract. 2009;15(4):660–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Leape LL. Preventing adverse drug events. Am J Health Syst Pharm. 1995;52(4):379–82.PubMedGoogle Scholar
  19. 19.
    Bergkvist A, Midlov P, Hoglund P, Larsson L, Bondesson A, Eriksson T. Improved quality in the hospital discharge summary reduces medication errors–LIMM: Landskrona Integrated Medicines Management. Eur J Clin Pharmacol. 2009;65(10):1037–46.PubMedCrossRefGoogle Scholar
  20. 20.
    Bondesson A, Eriksson T, Kragh A, Holmdahl L, Midlöv P, Höglund P. In-hospital medication reviews reduce the number of unidentified drug-related problems. In: Bondesson Å, editor. Aspects on optimisation of drug therapy in the elderly. Dissertation, Lund University.Google Scholar
  21. 21.
    Midlov P, Deierborg E, Holmdahl L, Hoglund P, Eriksson T. Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital. Pharm World Sci. 2008;30(6):840–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Institute for HealthCare Improvement. Prevent Adverse Drug Events (Medication Reconciliation) http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/Medication+Reconciliation+Review.htm. Accessed 10 Oct 2010.
  23. 23.
    Bondesson A, Hellström L, Eriksson T, Höglund P. A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data. J Eval Clin Pract. 2009;15(4):713–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Cipolle R, Strand LM, Morley PC. Pharmaceutical Care Practice. New York: The McGraw-Hill Companies Inc; 1998.Google Scholar
  25. 25.
    ATC classification index with DDDs. WHO collaborating centre for drug statistics methodology. Oslo; 2006.Google Scholar
  26. 26.
    Blix HS, Viktil KK, Moger TA, Reikvam A. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci. 2006;28(3):152–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Zillich AJ, Doucette WR, Carter BL, Kreiter CD. Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective. Value Health. 2005;8(1):59–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Klopfer JD, Einarson TR. Acceptance of pharmacists’ suggestions by prescribers: a literature review. Hosp Pharm 1990;25(9):830–2, 4–6.Google Scholar
  29. 29.
    van Mil JW, Westerlund LO, Hersberger KE, Schaefer MA. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859–67.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Anna Bergkvist Christensen
    • 1
    • 3
    • 4
    Email author
  • Linda Holmbjer
    • 2
  • Patrik Midlöv
    • 5
    • 6
  • Peter Höglund
    • 3
  • Lisa Larsson
    • 2
  • Åsa Bondesson
    • 2
    • 3
  • Tommy Eriksson
    • 2
    • 3
  1. 1.Apoteket Farmaci, Hospital PharmacySkåne University HospitalMalmöSweden
  2. 2.Apoteket Farmaci, Hospital PharmacySkåne University HospitalLundSweden
  3. 3.Department of Clinical PharmacologyLund UniversityLundSweden
  4. 4.MalmöSweden
  5. 5.Department of Clinical Sciences in Malmö—General Practice/Family MedicineLund UniversityLundSweden
  6. 6.Centre for Primary Health Care ResearchLund UniversityLundSweden

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