title: Practical evaluation of the drug-related problem management process in Swiss community pharmacies.
abstract: OBJECTIVE
  To develop and evaluate a coding system integrated into pharmaceutical software to routinely report and assess the process of community pharmacists' interventions related to medical prescriptions.
  
  
  METHODS
  A convenient sample of 20 Swiss community pharmacies.
  
  
  METHODS
  Pharmacists documented their interventions concerning all drug-related problems (DRPs) related to medical prescriptions during four consecutive weeks in 2005. The coding system assesses each step of the DRP management process; that is, the type of problem, possible negative outcomes, pharmaceutical decisions, and individuals involved. In order to be comprehensive, the management process of technical problems related to prescriptions and clinical DRPs was analysed separately.
  
  
  METHODS
  DRP intervention rate and characterization of each step of the process.
  
  
  RESULTS
  Of 38,663 prescriptions, 287 clinical DRPs required interventions. This corresponds to a mean intervention rate of 0.77% per pharmacy (SD = 0.61%). There was a large variability among pharmacies (0-2.6%). Most of the clinical DRPs were associated with dosage problems (n = 91) and drug-drug interactions (n = 45). The most frequent potential negative outcomes reported were quantitative inefficacy (n = 101) and quantitative safety (n = 94). Two-thirds of clinical DRPs required a prescription modification (n = 186), the most frequent being a change in dosage or drug regimen. In 110 interventions (38%), physicians were immediately contacted to take part in the decision. In 122 interventions (43%), pharmacists managed the interventions alone. However, in 55 interventions (19%), pharmacists managed the DRPs with the patient. From these 287 clinical interventions, 134 different codes were reported. Seven hundred and thirty-six technical problems related to prescriptions required intervention, which corresponded to a mean intervention rate of 1.90% per pharmacy. The main type of problem was a discrepancy with the medication record (n = 208). There were 494 instances that required a prescription modification. Pharmacists resolved 45% of all technical problems by themselves.
  
  
  CONCLUSIONS
  The developed coding system could describe the management process for DRPs. The observed intervention rate and the frequency of steps involved were comparable to those previously observed for pharmacists' interventions. Data regarding the entire process used to manage drug-related problems can be useful in improving medication safety, education, and collaborative care.
authors.affiliation: Ambulatory Care and Community Medicine Department, Community Pharmacy Unit, Rue du Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Krähenbühl
authors.forename: Bertha
authors.initials: B
authors.lastname: Kremer
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guignard
authors.forename: Olivier
authors.initials: O
authors.lastname: Bugnon
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010595:Pharmacists; D024382:Professional Role; D011787:Quality of Health Care; D012984:Software; D013557:Switzerland
chemical_list: D004364:Pharmaceutical Preparations