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Community Pharmacist Plaza Primo de Rivera 1 33001 Oviedo, Spain fax 34-985-283946 flortoledo{at}jet.es Vice President Pharmaceutical Care Foundation Barcelona, Spain
Member Pharmaceutical Care Foundation
Community Pharmacist Member Pharmaceutical Care Foundation
Community Pharmacist Member Pharmaceutical Care Foundation
Community Pharmacist Member Pharmaceutical Care Foundation
Community Pharmacist Member Pharmaceutical Care Foundation
Published Online, August 3, 2004. www.theannals.com, DOI 10.1345/aph.1D182e
Despite its appearance and name, the DRP classification from the 2002 Consensus (Granada-II)2 was not as consensual as the previous DRP classification attained in the first Granada Consensus in 1998 (Granada-I).3 Therefore, Granada-II cannot be taken as a review of Granada-I, but rather as an alternative approach.
We belong to the group who did not accept the second consensus of 2002 and we are working daily with the classification of Granada-I. The main differences between both classifications may be found in the DRP concept and the wording of categories in the classification.
As van Mil et al.1 write, in the Granada-I classification the DRP concept was defined as a "health problem of the patient in general...," but "health problem" was classified immediately as "anything that provokes the action of any health provider." This approach places the 1998 DRP concept in the same line of thought of Hepler and Strand4 and PCNE5: "...a DRP is any event or situation."
As referred by van Mil et al., in the Granada-II classification, the DRP concept adopted by the new group is "...the negative clinical outcomes of pharmacotherapy...," much more in the line of thought of Cipolle et al.,6 who believe "...DRPs are any undesirable event experienced by the patient."
The core differences between these 2 positions about the nature of DRPs are: Must we (pharmacists) look at the patient's health problems when they are using drugs, or must we look at the problems of drug use within each patient?
As a consequence of that basic disagreement on the underlying DRP concept, the DRP categories appearing in both classifications naturally differ. Granada-I classifies drug uses that either have resulted in or may result in a health problem for the patient. Therefore, the wording corresponding to each of them is "the patient uses, or is not using, or is using too much," and so on. This is correctly reproduced in Appendix I of van Mil et al.'s article, but is incorrectly identified as the classification from Granada-II (reference 8 in the article) rather than Granada-I (reference 21).1 Granada-II classifies negative clinical outcomes of pharmacotherapy; in consequence, the wording for each category is "the patient suffers a health problem because...". As van Mil et al. pointed out, preventable problems are omitted from the classification, even from the concept. This focus on already suffering patients seems inadequate when consideration is made of the observational difficulties for many clinical features in community pharmacy practice.
References
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