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MEDICATION SAFETY

Survey of Drug-Related Problems Identified by Community Pharmacies

Research Associate, Center for Drug Information and Pharmacy Practice, ABDA-Federal Union of German Associations of Pharmacists, Berlin, Germany

Nina Griese, PhD

Research Associate, Center for Drug Information and Pharmacy Practice, ABDA-Federal Union of German Associations of Pharmacists, Berlin

Martin Schulz, PhD

Head, Center for Drug Information and Pharmacy Practice, ABDA-Federal Union of German Associations of Pharmacists, Berlin; Adjunct Professor, Department of Pharmacology, Johann Wolfgang Goethe-University, Frankfurt at Main, Germany

Reprints: Dr. Schulz, Center for Drug Information and Pharmacy Practice (ZAPP), ABDA-Federal Union of German Associations of Pharmacists, Jaegerstrasse 49/50, 10117 Berlin, Germany, fax 49 30 40004-243, M.Schulz{at}abda.aponet.de

BACKGROUND: A drug-related problem (DRP) is defined as an event or circumstance that actually or potentially interferes with desired health outcomes. DRPs can lead to ineffective pharmacotherapy and may cause drug-related morbidity and mortality. Most DRPs are avoidable and community pharmacies are assuming an active role in preventing and solving DRPs.

OBJECTIVE: To identify the spectrum of DRPs encountered in community pharmacies.

METHODS: In 2005, a nationwide survey in Germany was conducted in community pharmacies to record all identified DRPs. Participating community pharmacies were free to select one week within the designated study period (February-May) and were instructed to record basic statistics (eg, number of patient interactions, number of prescriptions filled/nonprescription [over-the-counter; OTC] drugs dispensed per week), as well as patient-, problem-, and intervention-related data (eg, patient age and sex, whether a prescription-only or OTC drug was involved in the DRP, the time needed for problem resolution). DRPs were categorized using a modified version of the PI-Doc (problem-intervention-documentation) classification system.

RESULTS: Community pharmacies that participated in the study (N = 1146) documented 10,427 DRPs (9.1 DRP per pharmacy per week). A broad spectrum of DRPs was identified, with 9 of 10 cases involving prescribed medicines. DRPs arose on 3 primary levels: the prescription-, the patient-, and the delivery level. Overall, drug-drug interactions were the most frequently reported DRP (8.6%) and, according to community pharmacies, more than 80% of identified DRPs could be resolved completely. The prescribing physician was contacted in 60.5% of all such cases. Median time needed for solving a DRP was 5 minutes.

CONCLUSIONS: Pharmacists in the community pharmacy setting are well suited to identify and resolve DRPs. Ensuring the proper use of both prescription and OTC drugs is one of the basic responsibilities of pharmacists. This specific role of pharmacists within the healthcare system needs to be more fully recognized.

Key Words: ambulatory care, community pharmacy, drug-related problems, drug safety, medication error

Published Online, October 9, 2007. www.theannals.com, DOI 10.1345/aph.1K207