title: [Place of clinical pharmacist in the management of drugs in patients with hypertension].
abstract: OBJECTIVE
  To synthesize pharmacists' interventions made in the department of internal medicine and hypertension of university hospital of Toulouse and assess the impact on medication orders.
  
  
  METHODS
  This is a single-center, prospective study using pharmacists' interventions recorded between September 2013 and March 2014 on the Act-IP(©) website of the French Society of Clinical Pharmacy. The clinical pharmacist is present everyday in the unit to establish the medication reconciliation of new patients (the process of comparing a patient's medication orders to all of the medications that the patient has been taking), and analysis of medication orders. When a risk of iatrogenic drug is identified, a therapeutic change is proposed to the prescriber.
  
  
  RESULTS
  A total of 2491 medication orders were analyzed for 7 months, leading to 39 pharmacists' interventions (1.6 pharmacists' interventions per 100 medication orders). The most commonly identified drug-related problems were improper administration (33%, n=13), not prescribed drug (21%, n=8), non-conformity to guidelines (18%, n=7), supratherapeutic dose (15%, n=6), and 13% (n=5) targeted prescribed treatment not administered, underdosing, incorrect administration or drug interaction. The most relevant molecules were atorvastatin (10%), bromazepam (8%) and levothyroxine (8%) and only 2 interventions targeted antihypertensive drugs. The rate of physicians' acceptance was 92%.
  
  
  CONCLUSIONS
  Pharmacists' interventions mainly concern the co-prescriptions of antihypertensive drugs and very few antihypertensive drugs. The clinical pharmacist contributes to preventing iatrogenic in patients with hypertension with a very good acceptance by the clinician.
authors.affiliation: Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: flavie.boye@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Boyé
authors.affiliation: Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Sallerin
authors.affiliation: Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Ah Kang
authors.affiliation: Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Arnaud
authors.affiliation: Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: J B
authors.initials: JB
authors.lastname: Kantambadouno
authors.affiliation: Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Amar
authors.affiliation: Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Chamontin
authors.affiliation: Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Bouhanick
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: Analyse pharmaceutique; Co-prescriptions; Conciliation médicamenteuse; Hypertension; Hypertension artérielle; Interventions pharmaceutiques; Medication orders; Medication reconciliation; Pharmaceutical analysis; Pharmacists’ interventions; Prescriptions médicales; Prevention of iatrogenic; Prévention de l’iatrogénie