Quantifying drug-related problems in community pharmacy practice: A pharmacoepidemiological study from Greece
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INTRODUCTION
Drug-related-problems (DRPs) are encountered daily in prescription medicines at the community pharmacy but they are neither documented nor evaluated systematically. Population ageing in Greece is expected to increase polypharmacy and consequently DRPs, thus deteriorating patients’ health and pressuring the already underfunded health system. Community pharmacists are ideally placed to review patients’ medicines and in collaboration with physicians resolve identified issues.
OBJECTIVES
The primary outcomes of the study were to define the number and nature of DRPs identified in prescription medicines at an urban community pharmacy in Greece. Secondary outcomes included the assessment of severity of errors and, for the evaluation part of the project, planned interventions to address them.
METHODS
Our study was divided into two parts: the main part which included the evaluation of the current service and a following small-scale improvement project. For the first aspect, all prescription medicines dispensed from the pharmacy within one month were analyzed, using primary data extracted directly from pharmacy prescription and medication records. Medication characteristics as indicated in prescriptions (name of drug, dosage, formulation, dosing interval) and patients’ medication records were utilized as sources of information. The identification of DRPs was based mainly on explicit criteria and reliable sources. Potential DRPs were classified following the Pharmaceutical Care Network Europe (PCNE) classification system (2019) while their severity was assessed and documented according to a tool developed by Abdel-Qader et al . (2010). A comprehensive approach of medication review as defined in “Polypharmacy Guidance: Realistic Prescribing” (Scottish Government Polypharmacy Model of Care Group, 2018) and patient interviews as an additional source was followed for the 4 selected patients in the second part of the study.
RESULTS/DISCUSSION
In 635 prescriptions containing 1464 medicines we identified 364 DRPs in 529 different patients. The most common problem was related with a possible adverse drug event (P2.1, 62.1%) while 62% of the causes that led to problems belonged to inappropriate combination of drugs (C1.4), inappropriate drug (C1.2), drug dose too high (C3.2) and duration of treatment too long (C4.2). Most DRPs were characterized as significant (n=202, 55.5%) and minor (n=110, 30.2%) while the intervention “drug changed to” (I3.1, 25.8%) was the most frequent among the planned interventions. In the improvement project, 39 DRPs were identified in the 4 enrolled patients, including errors associated with potential inappropriate omissions and absence of monitoring not discovered in the first part of the study.
CONCLUSION
We quantified the potential DRPs encountered in a community pharmacy and discovered that for every 4 medicines dispensed 1 potential DRP was identified. Even if all errors will not result in harm, they will create additional work and possibly lead to prescribing cascade. Additional sources of information, like the patient interviews we incorporated in the improvement project, are expected to increase the number and consistency of findings. Finally, the value of community pharmacists as a vital component of primary care was pointed out.
