Abstract
Background Drug-related problems (DRPs) can have an important impact on the effectiveness and safety of pharmacotherapy. In Germany, the frequency of DRPs in prescribed medicines in ambulatory care is not yet known. Objective To quantify DRPs in prescribed medicines identified by community pharmacists (CPs) at the time the medicine is dispensed. Setting German CPs in four different regions. Method We invited CPs to document one hundred consecutive patients presenting prescriptions using a standardized documentation form. For each patient, person- and medication-related as well as identified DRP-related data were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed. Main outcome measure Nature and frequency of DRPs. Results In total, 143 CPs documented 14,231 patients with 24,422 prescribed drugs and identified DRPs in 2,556 patients (18.0 %). Analyses resulted in 0.23 DRPs per patient and 0.13 DRPs per prescribed medicine. Four DRPs were responsible for almost 70 % of all DRPs: Potential drug–drug interaction (22.9 %), dose not known to patient (21.7 %), patient insecure due to generic substitution (13.5 %), and insufficient patient knowledge of correct drug use (10.9 %). If a patient’s drug file was kept in the pharmacy, specific types of DRPs were detected more frequently e.g., drug–drug interactions (p < 0.001). Interventions primarily comprised counselling, monitoring, and changing drug or instructions for use. The prescribing physician was contacted in 28 % of DRPs resulting in a change of these prescriptions in 50 % of the cases. Overall and according to the pharmacists, more than 90 % of the DRPs detected were partially (10.4 %) or completely (85.4 %) solved. Conclusion We quantified DRPs in prescribed medicines in daily ambulatory care practice in Germany. When filling a prescription, in nearly 20 % of the patients relevant DRPs were revealed. According to the pharmacists, the majority could be partially or completely solved during the encounter at the pharmacy. Keeping a patient’s drug file including patient specific data may facilitate the detection of DRPs and shall, therefore, be offered to patients more often.
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References
Pharmaceutical Care Network Europe (PCNE). The PCNE classification V6.2. http://www.pcne.org/sig/drp/drug-related-problems.php. Accessed 3 July 2012.
Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24:46–54.
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279:1200–5.
Pouyanne P, Haramburu F, Imbs JL, Begaud B. Admissions to hospital caused by adverse drug reactions: cross sectional incidence study. French pharmacovigilance centres. BMJ. 2000;320:1036.
Westerlund T, Marklund B. Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems. J Clin Pharm Ther. 2009;34:319–27.
Winterstein AG, Sauer BC, Hepler CD, Poole C. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36:1238–48.
Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155:1949–56.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41:192–9.
Eichenberger PM, Lampert ML, Kahmann IV, van Mil JW, Hersberger KE. Classification of drug-related problems with new prescriptions using a modified PCNE classification system. Pharm World Sci. 2010;32:362–72.
Hämmerlein A, Griese N, Schulz M. Survey of drug-related problems identified by community pharmacies. Ann Pharmacother. 2007;41:1825–32.
Lewinski D, Wind S, Belgardt C, Plate V, Behles C, Schweim HG. Prevalence and safety-relevance of drug-related problems in German community pharmacies. Pharmacoepidemiol Drug Saf. 2010;19:141–9.
Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother. 2001;35:1343–9.
Westerlund T, Almarsdottir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7:40–50.
Eickhoff C, Schulz M. Pharmaceutical care in community pharmacies: practice and research in Germany. Ann Pharmacother. 2006;40:729–35.
Eickhoff C, Hämmerlein A, Griese N, Schulz M. Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol Drug Saf. 2012;21:254–60.
ABDA—Bundesvereinigung Deutscher Apothekerverbände. Leitfaden “Beratung in der Apotheke”; 2010.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo; 2003.
ABDATA Pharma-Daten-Service. ABDA-Datenbank [computer program]. Werbe- und Vertriebsgesellschaft Deutscher Apotheker mbH. Germany: Eschborn; 2010.
Ax F, Branstad J-O, Westerlund T. Pharmacy counselling models: a means to improve drug use. J Clin Pharm Ther. 2010;35:439–51.
Benrimoj SI, Langford JH, Berry G, Collins D, Lauchlan R, Stewart K, et al. Clinical intervention rates in community pharmacy: a randomised trial of the effect of education and a professional allowance. Int J Pharm Pract. 2003;11:71–80.
Poston J, Kennedy R, Waruszynski B. Initial results from the community pharmacist intervention study. Can Pharm J. 1995;127:18–24.
Rupp MT, DeYoung M, Schondelmeyer SW. Prescribing problems and pharmacist interventions in community practice. Med Care. 1992;30:926–40.
van Mil JW, Dudok van Heel MC, Boersma M, Tromp TF. Interventions and documentation for drug-related problems in Dutch community pharmacies. Am J Health Syst Pharm. 2001;58:1428–31.
Andersson AC, Brodin H, Nilsson JLG. Pharmacist interventions in relation to patient drug-related problems. J Soc Adm Pharm. 2003;20:82–91.
Buurma H, De Smet PA, van den Hoff OP, Egberts AC. Nature, frequency and determinants of prescription modifications in Dutch community pharmacies. Br J Clin Pharmacol. 2001;52:85–91.
Hawksworth GM, Corlett AJ, Wright DJ, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process. Br J Clin Pharmacol. 1999;47:695–700.
Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25:65–9.
Westein MP, Herings RM, Leufkens HG. Determinants of pharmacists’ interventions linked to prescription processing. Pharm World Sci. 2001;23:98–101.
Acknowledgments
We thank all participating community pharmacists for making this piece of research possible, Christiane Sauerwein for generating the database and data analyses, and Susanne vom Scheidt, both from the Department of Medicine at ABDA, Berlin, for supporting study organization and critical reading of the manuscript.
Funding
This study was funded by ABDA—Federal Union of German Associations of Pharmacists, Berlin, Germany.
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None declared.
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Nicolas, A., Eickhoff, C., Griese, N. et al. Drug-related problems in prescribed medicines in Germany at the time of dispensing. Int J Clin Pharm 35, 476–482 (2013). https://doi.org/10.1007/s11096-013-9769-9
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DOI: https://doi.org/10.1007/s11096-013-9769-9