title: [Pharmacists' interventions conducted by hospital pharmacists on psychotropic drugs pharmacotherapy].
abstract: BACKGROUND
  The French Society of Clinical Pharmacy (SFPC) through the special interest group "standardization and optimization of clinical pharmacy activities" stated that the study of pharmacists' interventions (PIs) conducted during prescription analysis was a priority. The SFPC developed an internet website named Act-IP(®) (http://www.sfpc.eu/fr/) where French speaking pharmacists were able to document PIs using a normalized codification. The objective of this study was to analyze medication-related problems linked to psychotropic drugs in hospital and to investigate PIs performed during prescription analysis.
  
  
  METHODS
  This is a multicenter, retrospective, observational study using PIs involving psychotropic medications recorded between September 2006 and February 2009 on the Act-IP(®) website.
  
  
  RESULTS
  Four thousand six hundred and twenty PIs recorded by 165 pharmacists in 57 hospitals were related to psychotropic drugs. Patients concerned by these drug-related problems were 64 years old on average. Seven categories of medication-related problems represented more than 69% of PIs (1.1-Non Conformity of the drug choice compared to the formulary; 4.1 Supratherapeutic dose; 5.3 Therapeutic redundancy; 6.2 Drug interaction (all levels of severity); 7.0 Adverse drug reaction; 8.3 Inappropriate drug form; 8.5 Inappropriate timing of administration). The PIs related to 9.2 Patient's non compliance, 2.0 Untreated indication and 3.2 Length of the treatment too short were infrequent (less than 1%). The most common type of intervention was the dose adjustment. Almost 45% of these PIs involved Zopiclone or Zolpidem prescription in elderly patients. Seven hundred and nine drug interactions were identified by pharmacists. The most common type of drug interaction considered the risk of cardiac arrhythmias due to antipsychotic medications. One hundred and thirty-three PIs concerned adverse drug reaction. The most frequent adverse drug reactions were a fall (36 PIs), hemorrhage/bleeding (32 PIs), drowsiness (12 PIs) and extrapyramidal syndrome (12 PIs). Antidepressant drugs were the greatest pharmacological class concerning adverse drug reaction. The overall acceptance rate was 57%. Eight hundred and seventy-four PIs (19%) were refused and 1111 (24%) were non-assessable.
  
  
  CONCLUSIONS
  PIs avoids drug-related problems, such as the polyprescription of benzodiazepine or supratherapeutic dose. However, few PIs concern compliance to therapy or polyprescription of antipsychotic drugs. These two categories of medication-related problems are known to be an issue in mental health therapy. The lack of guidelines describing mental health pathology (such as the HAS guideline) is an obstacle for performing evidence-based PIs. The lack of information describing the context of the prescription is a limitation of this study. In order to improve their practice, pharmacists have to focus more on the context in which patients are evolving, and to take into account its entire situation based on Anglo-Saxon approaches. A second way is to identify clinical settings where PIs are useful and to describe PIs needed. Doctors and pharmacists should get together and talk about these clinical situations and PIs, because some may be misunderstood or disapproved by prescribers. This collaboration could take the form of a thesaurus combining clinical situation and PIs.
  
  
  CONCLUSIONS
  It appears important for pharmacists to show their daily involvement in the quality of medical care. This feedback on medication problems encountered and PIs proposed should help prescribers to identify clinical situations at risk. Nevertheless, this study also suggests that progress is possible. Dialogue must allow pharmacists and physicians to delete misunderstandings about their practices.
authors.affiliation: Service de pharmacie, EPSM Novillars-Besançon, rue du Dr-Charcot, 25220 Novillars, France.
authors.forename: G
authors.initials: G
authors.lastname: Parent
authors.affiliation: Service de pharmacie, EPSM-Morbihan, rue de l'Hôpital, BP 10, 56826 Saint-Avé, France. Electronic address: francois-xavier.rose@epsm-morbihan.fr.
authors.forename: F-X
authors.initials: FX
authors.lastname: Rose
authors.affiliation: CNRS/TIMC, IMAG UMR 5525, université Joseph-Fourier Grenoble 1, Themas, 38041 Grenoble, France; Pôle pharmacie, CHU de Grenoble, BP 217, 38043 Grenoble 09, France.
authors.forename: P
authors.initials: P
authors.lastname: Bedouch
authors.affiliation: Service pharmacie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Conort
authors.affiliation: Service pharmacie, hôpital de la Croix-Rousse, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France.
authors.forename: B
authors.initials: B
authors.lastname: Charpiat
authors.affiliation: Centre hospitalier Auban-Moët, 137, rue de l'Hôpital-Auban-Moët, 51200 Epernay, France.
authors.forename: M
authors.initials: M
authors.lastname: Juste
authors.affiliation: Service pharmacie, centre hospitalier Lucien-Hussel, Mont-Salomon, BP 127, 38209 Vienne cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Roubille
authors.affiliation: CNRS/TIMC, IMAG UMR 5525, université Joseph-Fourier Grenoble 1, Themas, 38041 Grenoble, France; Pôle pharmacie, CHU de Grenoble, BP 217, 38043 Grenoble 09, France.
authors.forename: B
authors.initials: B
authors.lastname: Allenet
mesh_terms: D000368:Aged; D004347:Drug Interactions / Q000502:physiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D010595:Pharmacists / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012189:Retrospective Studies; D012957:Societies, Pharmaceutical / Q000592:standards
chemical_list: D011619:Psychotropic Drugs
keywords: Clinical pharmacy; Drug-related problems; Iatrogénie; Intervention pharmaceutique; Pharmacie clinique; Pharmacists’ intervention; Problèmes médicamenteux; Psychotropes; Psychotropic drug