Pharmaceutical interventions on prescribed medicines in community pharmacies: focus on patient-reported problems.

Background While dispensing prescribed medicines, pharmacists frequently encounter technical and clinical problems that require a pharmaceutical intervention. Objective To describe the pharmaceutical interventions performed by community pharmacists while dispensing prescribed medicines and to investigate, in-depth, the patient-reported problems with the prescribed medicines that triggered pharmaceutical interventions. Method Twenty-one pharmacists each collected 30 prescriptions requiring a pharmaceutical intervention on five selected days within a five-week period. All pharmaceutical interventions were classified using the PharmDISC system. Results Of all 430 pharmaceutical interventions, 286 (66.5%) pharmaceutical interventions had a clinical cause and 144 (33.5%) pharmaceutical interventions a technical cause. Pharmacists mainly intervened to substitute a drug (n = 132, 30.7%), adjust a dose (n = 57, 13.3%), and clarify/complete information (n = 48, 11.2%). A total of 243 (56.5%) pharmaceutical interventions resulted in a change of the prescription. The implementation rate of pharmaceutical interventions reached 88.6%. Altogether, patient-reported problems triggered 99 (23.0%) pharmaceutical interventions. In 15 (15.2%) of these PIs, contact with the prescriber was necessary, whereas 61 (84.8%) PIs only involved the pharmacist. Conclusion While dispensing prescribed medicines, pharmacists performed individualised pharmaceutical interventions to solve or prevent drug-related problems. That almost a quarter of all pharmaceutical interventions triggered by patient-reported problems highlights the importance of direct patient-pharmacist interaction when dispensing prescribed medicines.

Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities.

BACKGROUND: Patient counselling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. This study aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice and to identify factors influencing counselling provision; Methods: An observational study was conducted in community pharmacies in Basel, Switzerland. One master student in pharmacy performed non-participatory observations for one day at each of the participating community pharmacies. Patient characteristics, counselling content, additional activities, and pharmaceutical interventions were documented on a structured checklist; Results: 556 prescription encounters (PE) in 18 participating community pharmacies were observed (269 first prescriptions; 287 refill prescriptions). Patients were regular customers (n = 523, 94.1%) and 53.8 ± 23.4 years old. Counselling was provided to 367 (66.0%) customers on 2.9 ± 3.1 themes per PE. Factors influencing counselling were dispensing by the pharmacist, new customer, customer who did not refuse counselling, customer with a first prescription, with a prescription resulting in a pharmaceutical intervention, and a prescription filled by carers. During 144 PEs, 203 interventions were documented. Pharmacists proposed few additional activities and performed no cognitive pharmaceutical service; Conclusions: Our study quantified counselling and additional services at the dispensing of prescribed medicines and identified influencing factors on counselling provision at the patient, prescription, and pharmacy level.

Documentation of pharmaceutical care: development of an intervention oriented classification system.

Background A standardised classification system of pharmaceutical interventions (PI) is in use in several Swiss hospitals, whereas none exists for community pharmacies to date. To promote information exchange between both settings, a compatible structure of the classification system is needed. Objective To develop an intervention oriented classification system for community pharmacies named PharmDISC based on the hospital system; to test it on interrater reliability, appropriateness, interpretability, and face and content validity; to assess pharmacists' opinions. Setting Seventy-seven Swiss community pharmacies. Method Based on previous studies, a modified classification system was developed. Fifth-year pharmacy students (n = 77) received a two-hour training and classified three model PIs with which Fleiss-Kappa coefficients K were calculated to determine interrater reliability. In the community pharmacies, each student consecutively collected ten prescriptions that required a PI. A focus group interview was conducted with pharmacists (n = 9). The anonymised transcript was analysed using thematic analysis. Main outcome measure Number of classified PIs, interrater reliability, pharmacists' opinion/suggestions. Results The classification system includes 5 categories and 52 subcategories. Most of the 725 PIs (94.6%) were completely classified. The PharmDISC system reached an overall substantial user agreement (K = 0.61). Despite some points for optimisation, the pharmacists were satisfied with the PharmDISC system. They recognised the importance of PI documentation and believed that this may allow traceability, facilitate communication within the team and other healthcare professionals, and increase quality of care. Conclusion The PharmDISC system was valid and reached substantial interrater reliability. Refinement based on the pharmacists' suggestions resulted in a final version to be tested in an observational study with community pharmacists.

Documentation of pharmaceutical care: Validation of an intervention oriented classification system.

RATIONALE, AIMS, AND OBJECTIVES: During the dispensing process, pharmacists may come across technical and clinical issues requiring a pharmaceutical intervention (PI). An intervention-oriented classification system is a helpful tool to document these PIs in a structured manner. Therefore, we developed the PharmDISC classification system (Pharmacists' Documentation of Interventions in Seamless Care). The aim of this study was to evaluate the PharmDISC system in the daily practice environment (in terms of interrater reliability, appropriateness, interpretability, acceptability, feasibility, and validity); to assess its user satisfaction, the descriptive manual, and the online training; and to explore first implementation aspects. METHOD: Twenty-one pharmacists from different community pharmacies each classified 30 prescriptions requiring a PI with the PharmDISC system on 5 selected days within 5 weeks. Interrater reliability was determined using model PIs and Fleiss's kappa coefficients (κ) were calculated. User satisfaction was assessed by questionnaire with a 4-point Likert scale. The main outcome measures were interrater reliability (κ); appropriateness, interpretability, validity (ratio of completely classified PIs/all PIs); feasibility, and acceptability (user satisfaction and suggestions). RESULTS: The PharmDISC system reached an average substantial agreement (κ = 0.66). Of documented 519 PIs, 430 (82.9%) were completely classified. Most users found the system comprehensive (median user agreement 3 [2/3.25 quartiles]) and practical (3[2.75/3]). The PharmDISC system raised the awareness regarding drug-related problems for most users (n = 16). To facilitate its implementation, an electronic version that automatically connects to the prescription together with a task manager for PIs needing follow-up was suggested. Barriers could be time expenditure and lack of understanding the benefits. CONCLUSION: Substantial interrater reliability and acceptable user satisfaction indicate that the PharmDISC system is a valid system to document PIs in daily community pharmacy practice.

Mapping clinical pharmacy practice in Swiss hospitals: a cross-sectional study.

BACKGROUND: Clinical pharmacy activities developed significantly in the last decade. The extent and organisation of these activities in Switzerland remained unknown. OBJECTIVES: To map clinical pharmacy services (CPS) provided in Swiss hospitals and to discuss their development focusing on different cultural regions and healthcare systems. METHODS: We enrolled all chief hospital pharmacists affiliated with the Swiss Society of Public Health Administration and Hospital Pharmacists (n=47) for an online survey. We asked them to describe the extent and organisation of CPS concerning patient-related, therapy-related or process-related activities, the structural organisation and the available human resources. RESULTS: The survey took place from March to April 2013. It was completed by 44 chief hospital pharmacists (return rate 94%), representing the hospital landscape in Switzerland comprehensively. Thirty-three (75%) hospitals offered regular CPS and seven (16%) planned to do so. Institutions in regions without drug-dispensing physicians rather employed pharmacists assigned with clinical activities (n=20, 22% of 135.3 full-time equivalent (FTE)) than regions with partial (n=8, 7% of 35.8 FTE) or unrestricted drug dispensing by physicians (n=16, 6% of 68.1 FTE, p=0.026). Of hospitals with implemented CPS, 73% had weekly interprofessional ward rounds, and in 9.1%, clinical pharmacists daily reconciled medicines at patient discharge. CONCLUSIONS: Our data show regional differences in the implementation and pattern of CPS. A significant correlation to drug dispensing by physicians in ambulatory care and human resources provided for CPS was found. While interprofessional ward rounds were performed periodically, seamless care activities by clinical pharmacists remained insufficiently established.

Demonstrating the clinical pharmacist's activity: validation of an intervention oriented classification system.

BACKGROUND: Clinical pharmacists are increasingly involved in detecting and solving drug-related problems. To document their performance, a convenient tool to code pharmaceutical interventions in daily practice is desirable. The Swiss Society of Public Health Administration and Hospital Pharmacists (GSASA) proposed to implement a new classification system for pharmaceutical interventions. OBJECTIVES: To develop and validate a classification system for pharmaceutical interventions and to compare it with the well-established Pharmaceutical Care Network Europe (PCNE) system. SETTING: Rehabilitation clinic, geriatric and orthopaedic wards of a 427-bed teaching hospital. METHODS: Development of the GSASA classification started with expert panel discussions and the validation of the first version (GSASA V1). To assess appropriateness, interpretability, and validity, clinical pharmacists documented during a 6-week period all interventions using GSASA V1 and PCNE version 6.2 (V6.2). Acceptability and feasibility were tested by an 8-item questionnaire with 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), and inter-rater reliability (Fleiss-Kappa coefficients κ) was determined. After revision, the second version (V2) was assessed again for reliability. MEAN OUTCOME MEASURES: User's agreement/satisfaction, comprehensiveness/reliability of the classification system. RESULTS: The GSASA V1 includes 4 categories and 35 subcategories. Of 115 interventions classified with GSASA V1, 93 (80.9 %) could be completely classified in all categories. This explains that 3 of 6 users could be not satisfied with the comprehensiveness of GSASA V1 (mean user agreement 2.7 ± 0.8). The questionnaire showed that all users could find GSASA V1 (4.0 ± 0.0) easier to use than PCNE V6.2 (3.0 ± 0.9). Users were generally satisfied with the GSASA V1 (3.5 ± 0.8), especially with the adequate time expenditure (4.0 ± 0.7). Inter-rater reliability and acceptability of GSASA V1 were comparable to those of the PCNE V6.2. The agreement among the GSASA V1 users was substantial for the categories 'problem' (κ = 0.66), 'intervention' (κ = 0.74), and 'outcome' (κ = 0.63), while moderate agreement for the category 'cause' was obtained (κ = 0.53). The final system GSASA V2 includes 5 categories (addition of 'type of problem') and 41 subcategories. Total inter-rater reliability was moderate (κ = 0.52). CONCLUSION: The GSASA classification system appeared to be reliable and promising for documentation of pharmaceutical interventions in daily practice (practical and less time-consuming). The system is validated in terms of appropriateness, interpretability, validity, acceptability, feasibility, and reliability.