International Journal of Clinical Pharmacy

, Volume 34, Issue 5, pp 699–709 | Cite as

Preventable drug-related morbidity in community pharmacy: development and piloting of a complex intervention

  • Mara Pereira GuerreiroEmail author
  • Ana Paula Martins
  • Judith Anne Cantrill
Research Article


Background Preventable drug-related morbidity (PDRM) arising in the community is a problem of unacceptable magnitude. Effective interventions to reduce this problem will avoid unnecessary patient harm and waste of resources for the health care system. Objective To develop and pilot an intervention to manage the risk of PDRM in community pharmacy, underpinned by validated PDRM indicators. Setting Portuguese community pharmacy. Method Our work was informed by the Medical Research Council framework for the development and evaluation of complex interventions. Human error theory was considered as a theoretical framework for developing the intervention. Additionally, this stage consisted of a literature review, followed by two focus groups (17 community pharmacists) and interviews with 8 professional leaders. A 4-component intervention, was developed: (1) operationalisation of 4 validated PDRM indicators in dispensing encounters (‘dispensing’ indicators), and operationalisation of 25 validated indicators in patients enrolled in pharmaceutical care programmes (‘follow-up’ indicators), (2) pharmacist resource pack, (3) pharmacists’ training and (4) support scheme. Piloting consisted of a feasibility study in 15 community pharmacies and an acceptability study with participating pharmacists (n = 16). Main outcome measures Proportion of cases with counselling (dispensing indicators); proportion of cases assessable, proportion of cases at risk and proportion of cases with risk minimisation actions (follow-up indicators). Results Operationalization of dispensing indicators resulted in counselling in 44.1 % of cases (n = 666). Factors influencing acceptability included pharmacists’ perceptions of patients’ characteristics, interest and informational needs, as well as perceptions on the relevance of safety information. For follow-up indicators, data were available to assess most cases (93/105, 88.6 %). About half of the assessable cases were at risk of a PDRM event (n = 49; 51.6 %); pharmacists undertook risk minimization actions in 23 cases (46.9 %). Lack of time and inter-professional issues emerged as important factors influencing acceptability. Conclusions A novel risk management intervention was developed. Feasibility and acceptability of the 4-component intervention in Portuguese community pharmacy provided ‘proof of concept’, whilst highlighting aspects that need further refinement to better measure and maximise efficacy in future evaluative research.


Community pharmacy Indicators Patient safety Portugal Preventable drug-related morbidity 



The list of people that contributed to this research over the course of almost 4 years is very long, which makes it impossible to name them. We are, however, deeply grateful for their contribution to the execution of the work. A special thank you goes to research participants, without whom this would not have been possible. Community pharmacies in the feasibility study accommodated study requirements throughout 8 months, which is especially commendable.


This work was supported by The University of Manchester (UK) as part of a PhD programme and the Centre for Health Evaluation & Research, National Association of Pharmacies group (Portugal).

Conflicts of interest



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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Mara Pereira Guerreiro
    • 1
    • 2
    Email author
  • Ana Paula Martins
    • 1
  • Judith Anne Cantrill
    • 3
  1. 1.iMED.ULFaculdade de Farmácia da Universidade de Lisboa (FFUL)LisbonPortugal
  2. 2.Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM)Monte da CaparicaPortugal
  3. 3.School of Pharmacy and Pharmaceutical SciencesUniversity of ManchesterManchesterUK

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