Drug-related problems. Identification, characteristics and pharmacy interventions

Abstract

Introduction: Drug-related morbidity and mortality represent a major problem to patients, public health and society. Hence, there is a need to do more research in patients' medication practices and to find ways to improve the use of drugs. Pharmacy practitioners are in a unique position to identify, correct and prevent the occurrence of drug-related problems (DRPs) because of their training and regular contacts with patients. Objectives: To (1) develop instruments for the documentation of DRPs in pharmacy clients; (2) examine the frequency and characteristics of DRPs identified in community pharmacy practice and resulting interventions; (3) analyze relationships among the number and types of problems and patient characteristics, class of drug and symptoms; (4) explore pharmacy personnel and work site factors influencing the DRP identification and detection rates; (5) study pharmacy practitioners' views on computerized documentation of DRPs; and (6) develop, apply, and follow-up a pharmacy OTC counseling model, aimed at an improved management of problems related to symptoms and drug use in dyspepsia clients.Methods: (1) Development and application of (a) a manual and (b) a computerized systemfor the documentation of DRPs, patient variables and pharmacy interventions; (2) examination of pharmacy practitioners' views and experiences by the use of different attitudinal instruments; (3) development and application of a pharmacy OTC counseling model; and (4) telephone follow-up interviews of dyspepsia clients.Results: The developed documentation instruments worked well in daily practice according to the majority of the participating practitioners. Uncertainty about the aim of the drug, various dosage problems and therapy failure belonged to the most frequently identified DRPs. Several patient groups were significantly over-represented among the problems. The educational level of the pharmacy personnel and their commitment had significant effects on the DRP documentation rates. Patient drug counseling and switch of OTC drugs were common interventions. Pharmacy practitioners reported positive experiences of a developed IT-based DRP documentation system. Patients appreciated the pharmacy OTC counseling model used and complied with given self care advice. However, most referred patients did not see a physician. Conclusions: The research leading to this thesis has demonstrated a need for professional attention and intervention by pharmacy staff to identify, prevent and resolve DRPs in pharmacy clients. Education, experience, IT-based documentation and commitment favor DRP identification.A developed pharmacy OTC counseling model had a positive impact on outcomes in dyspepsia clients.