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International Journal of Clinical Pharmacy
Drug related problems identified by European community pharmacists in patients discharged from ho... more Drug related problems identified by European community pharmacists in patients discharged from hospital • E m a I . P a u l i n o , M a r c e l L . B o u v y, M i g u e l A . G a s t e l u r r u t i a , M a r a G u e r r e i r o a n d H e n k B u u r m a f o r t h e E S C P -S I R R e j k j a v i k C o m m u n i t y P h a r m a c y R e s e a r c h G r o u p *
Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from ... more Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Community pharmacists' interventions to detect, prevent and solve DRPs in this population are scarcely studied. To examine the nature and frequency of DRPs in community pharmacies among patients discharged from hospitals in several countries, and to examine several variables related to these drug related problems. The study was performed in 112 community pharmacies in Europe: Austria, Denmark, Germany, The Netherlands, Portugal and Spain. Community pharmacists asked patients with a prescription after discharge from hospital between February and April 2001 to participate in the study. A patient questionnaire was used to identify drug related problems. Pharmacists documented drug related problems, pharmacy interventions, type of prescriber and patient and pharmacy variables. 435 patients were included in the study. Drug related problems were identified in 277 patients (63.7%). Uncertainty or lack of knowledge about the aim or function of the drug (133; 29.5%) and side effects (105; 23.3%) were the most common DRPs. Practical problems were reported 56 times (12.4%) by patients. Pharmacists revealed 108 problems (24.0%) concerning dosage, drug duplication, drug interactions and prescribing errors. Patients with more changes in their drug regimens (drugs being stopped, new drugs started or dosage modifications) and using more drugs were more likely to develop DRPs. Community pharmacists recorded 305 interventions in 205 patients with DRPs. Pharmacists intervened mostly by patient medication counselling (39.0%) and practical instruction to the patient (17.7%). In 26.2% the intervention was directed towards the prescriber. In 28 cases (9.2%) the pharmacists' intervention led to a change of the drug regimen. This study shows that a systematic intervention by community pharmacists in discharged patients, or their proxies, is able to reveal a high number of DRPs that might be relevant for patient health outcomes. There should be more initiatives to insure continuity of care, since DRPs after discharge from hospital seem to be very common.
Objectives: To explore the opinions and experiences of a range of stakeholders on inter-professio... more Objectives: To explore the opinions and experiences of a range of stakeholders on inter-professional working relationships between community pharmacists and physicians. Study design: Five qualitative studies. Setting: Primary care. Population and Methods: Thirty-one community pharmacists, eight medical and pharmacy leaders, 12 physicians and 21 patients took part in interviews and focus groups reflecting on medicines management services in Portuguese community pharmacy. Data pertaining to inter-professional work was subjected to thematic content analysis with the aid of NVIVO® software. Results: Generally, datasets offer evidence of immature inter-professional working relationships. Data analysis suggests a mismatch between the role pharmacists perceived for themselves and physicians' perceptions. A second key theme in explaining barriers to inter-professional work is its perceived benefits. Once again, a mismatch was found between physicians, who generally perceived little benefit for patients or for themselves, and pharmacists, who were keen to collaborate and anticipated benefits for patients. A third key theme was that of role encroachment. Analysis suggests that territorial behaviour was evident in both professions. More clinical roles were perceived as an invasion of physicians' professional practice both by physicians and community pharmacists, but the latter showed unwillingness to compromise on these newly extended roles. Facilitators mentioned by participants included increasing awareness of the pharmacist's role and services, adopting aspects such as joint training, and informal and formal inter-professional meetings. The use of protocols for collaboration and clinical data sharing were also identified as facilitators for inter-professional work. Conclusions: Inter-professional work between community pharmacists and physicians appears to be in an early stage of development. Multi-modal strategies combining top-down and bottom-up approaches seem necessary to advance inter-professional work to a collaboration level that can contribute to patient safety in the medication use process.
International Journal of Clinical Pharmacy
Drug related problems identified by European community pharmacists in patients discharged from ho... more Drug related problems identified by European community pharmacists in patients discharged from hospital • E m a I . P a u l i n o , M a r c e l L . B o u v y, M i g u e l A . G a s t e l u r r u t i a , M a r a G u e r r e i r o a n d H e n k B u u r m a f o r t h e E S C P -S I R R e j k j a v i k C o m m u n i t y P h a r m a c y R e s e a r c h G r o u p *
Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from ... more Drug related problems (DRPs) are perceived to occur frequently when patients are discharged from the hospital. Community pharmacists' interventions to detect, prevent and solve DRPs in this population are scarcely studied. To examine the nature and frequency of DRPs in community pharmacies among patients discharged from hospitals in several countries, and to examine several variables related to these drug related problems. The study was performed in 112 community pharmacies in Europe: Austria, Denmark, Germany, The Netherlands, Portugal and Spain. Community pharmacists asked patients with a prescription after discharge from hospital between February and April 2001 to participate in the study. A patient questionnaire was used to identify drug related problems. Pharmacists documented drug related problems, pharmacy interventions, type of prescriber and patient and pharmacy variables. 435 patients were included in the study. Drug related problems were identified in 277 patients (63.7%). Uncertainty or lack of knowledge about the aim or function of the drug (133; 29.5%) and side effects (105; 23.3%) were the most common DRPs. Practical problems were reported 56 times (12.4%) by patients. Pharmacists revealed 108 problems (24.0%) concerning dosage, drug duplication, drug interactions and prescribing errors. Patients with more changes in their drug regimens (drugs being stopped, new drugs started or dosage modifications) and using more drugs were more likely to develop DRPs. Community pharmacists recorded 305 interventions in 205 patients with DRPs. Pharmacists intervened mostly by patient medication counselling (39.0%) and practical instruction to the patient (17.7%). In 26.2% the intervention was directed towards the prescriber. In 28 cases (9.2%) the pharmacists' intervention led to a change of the drug regimen. This study shows that a systematic intervention by community pharmacists in discharged patients, or their proxies, is able to reveal a high number of DRPs that might be relevant for patient health outcomes. There should be more initiatives to insure continuity of care, since DRPs after discharge from hospital seem to be very common.
Objectives: To explore the opinions and experiences of a range of stakeholders on inter-professio... more Objectives: To explore the opinions and experiences of a range of stakeholders on inter-professional working relationships between community pharmacists and physicians. Study design: Five qualitative studies. Setting: Primary care. Population and Methods: Thirty-one community pharmacists, eight medical and pharmacy leaders, 12 physicians and 21 patients took part in interviews and focus groups reflecting on medicines management services in Portuguese community pharmacy. Data pertaining to inter-professional work was subjected to thematic content analysis with the aid of NVIVO® software. Results: Generally, datasets offer evidence of immature inter-professional working relationships. Data analysis suggests a mismatch between the role pharmacists perceived for themselves and physicians' perceptions. A second key theme in explaining barriers to inter-professional work is its perceived benefits. Once again, a mismatch was found between physicians, who generally perceived little benefit for patients or for themselves, and pharmacists, who were keen to collaborate and anticipated benefits for patients. A third key theme was that of role encroachment. Analysis suggests that territorial behaviour was evident in both professions. More clinical roles were perceived as an invasion of physicians' professional practice both by physicians and community pharmacists, but the latter showed unwillingness to compromise on these newly extended roles. Facilitators mentioned by participants included increasing awareness of the pharmacist's role and services, adopting aspects such as joint training, and informal and formal inter-professional meetings. The use of protocols for collaboration and clinical data sharing were also identified as facilitators for inter-professional work. Conclusions: Inter-professional work between community pharmacists and physicians appears to be in an early stage of development. Multi-modal strategies combining top-down and bottom-up approaches seem necessary to advance inter-professional work to a collaboration level that can contribute to patient safety in the medication use process.