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Senior Lecturer Research Group on Pharmaceutical Care University of Granada Xeral Rubin, 27 36800 Redondela (PO), Spain fax 34 986 401 889 f_llimos{at}medynet.com
Professor of Biochemistry and Molecular Biology Research Group on Pharmaceutical Care University of Granada
Published Online, August 3, 2004. www.theannals.com, DOI 10.1345/aph.1D182a
Second, the Granada Consensus defines DRPs as negative clinical outcomes or change in health status resulting from pharmacotherapy.4 Yet, van Mil et al. present the Granada Consensus DRPs as process-of-care indicators in Appendix I (eg, pt. use dose, interval, or duration inferior to the one needed), not health outcomes. This is a crucial distinction. The correct 6 DRPs from the Granada Consensus are listed below, wherein quantitative refers to dose, frequency, or pharmacokinetic properties.
Clearly, the Granada Consensus defines DRPs as negative clinical outcomes. Table 1 shows 3 possible scenarios for a patient using drug therapy. In the prevention or proactive scenario, pharmacists identify risk factors of a negative outcome (eg, long-term use of a nonsteroidal antiinflammatory drug [NSAID] without gastric protection) and may make an intervention to prevent a negative outcome depending upon the risk and seriousness of the outcome. In the reactive scenario, pharmacists find an actual negative outcome, such as pain located in the upper part of the stomach. After finding the cause (eg, long-term use of an NSAID without gastric protection), pharmacists provide an intervention to improve processes of care by discontinuing the NSAID, initiating an alternative pain reliever, and/or adding a gastric protective medicine. These 2 different negative scenarios should not create confusion in a DRP classification system.
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Finally, van Mil et al.1 state that the Granada Consensus excludes potential problems, which is misleading. The Granada Consensus does not use the term "potential"—rather, we use "risk of DRP." For example, interventions made by pharmacists to avoid a gastrointestinal bleed would be documented with "risk of DRP 6."
As indicated in the review, DRP definitions use words such as "events," "circumstances," or "elements," and these terms are often difficult to define. This vagueness in terminology may arise because of our desire to classify everything done by pharmacists instead of classifying actual clinical situations. Agreement upon the definition of DRP should be achieved.
Footnotes
Comments on articles previously published are submitted to the authors of those articles. When no reply is published, either the author chose not to respond or did not do so in a timely fashion. Comments and replies are not peer reviewed.–ED.
References
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