Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care: a systematic literature review and international consensus development.

BACKGROUND: Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general definition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020. AIM: This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC. METHOD: A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modified Delphi technique to develop the definition of QIs for PhC. RESULTS: A total of 182 QI definitions were identified from 174 articles. Of these, 63 QI definitions (35%) cited one of five references as the source. Sixteen aspects that construct QI definitions were derived from the identified definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence definition of QIs for PhC: "quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists". CONCLUSION: Building upon existing definition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC.

Role of community pharmacy and pharmacists in self care in Sweden.

Background: Self care is an important concept, which is increasingly being applied by policy makers on a large scale. It is associated with improved health literacy and technological advances. Community pharmacy practitioners are easily accessible for self care counselling, purchase of non-prescription products and for referrals to other healthcare providers. Objective: To describe self care policies and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy. Methods: A search was conducted to retrieve self care policy documents and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy on respective websites, as well as personal contacts with key persons in pharmaceutical organizations and community pharmacy practice. Results: A new law on self care was adopted by the Swedish Parliament becoming effective in 2023. The law defines self care as a healthcare measure that has been assessed by a treating licenced healthcare practitioner to be possible to be performed by the patient him/herself. The law includes a wide range of measures. According to a Government Commission that followed Sweden's the National Pharmaceutical Strategy's Action Plan in 2018, the Medical Products Agency (MPA) was assigned to establish requirements of qualifications in self care counselling. In its report in late 2022, the MPA stated that self care counselling by community pharmacy practitioners plays an important role in society. The new requirements are expected to become effective in mid-2023. None of the four community pharmacy chains operating 97% of Sweden's community pharmacies have developed any specific self care policies, although self care counselling and sales of non-prescription products, as well as provision of some primary healthcare services, constitute important components of their operations. Furthermore, all Swedish pharmacies offer several digital self care solutions, supporting people to manage their own health. Neither the Swedish Pharmacy Association, representing most pharmacies, nor the Swedish Pharmacists Association, the trade union, have developed any self care policies. However, the Swedish Association of the Pharmaceutical Industry is promulgating Swedish self care reform using a systematic review of self care and which medicines should be over-the-counter. Conclusions: Self care is not currently established as a core pillar of a Swedish national health strategy. There are further opportunities to enable pharmacists to fulfil their potential in supporting individual wellbeing and promoting self care interventions. A new system needs to be created which fully integrates the promotion of everyday wellbeing, self care for self-treatable conditions and the management of long-term conditions.

Community pharmacy and primary health care in Sweden - at a crossroads.

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital ("online doctors") and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

Community pharmacy and primary health care in Sweden -at a crossroads

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital ("online doctors") and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business

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Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading?

RATIONALE, AIMS, AND OBJECTIVES: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. METHOD: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. RESULTS: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. CONCLUSIONS: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.

Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market.

BACKGROUND: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. OBJECTIVE: To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. METHODS: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old. RESULTS: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. CONCLUSIONS: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market

Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. Objective: To examine the adult general public’s views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals’ recommendation. Differences in how OTCs are perceived were however found with regards to respondents’ country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals’ recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden (AU)

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Medical care and drug-related problems: Do doctors and pharmacists speak the same language?

Optimal communication between physicians and pharmacists is important for patient care. However, pharmacists and doctors do not always seem to understand each other. They have been professionalized differently, and do not always speak the same language. Especially in the areas of prescribing, medication review, and medicine use, there can be differences in views. This contribution clarifies some essential concepts that doctors and pharmacists use. Thus we hope that our commentary contributes to a better understanding of each other's role and the importance of interprofessional cooperation for the benefit of the patient.

Swedish general practitioners' attitudes towards treatment guidelines - a qualitative study.

BACKGROUND: Drug therapy in primary care is a challenge for general practitioners (GPs) and the prescribing decision is influenced by several factors. GPs obtain drug information in different ways, from evidence-based sources, their own or others' experiences, or interactions with opinion makers, patients or colleagues. The need for objective drug information sources instead of drug industry-provided information has led to the establishment of local drug and therapeutic committees. They annually produce and implement local treatment guidelines in order to promote rational drug use. This study describes Swedish GPs' attitudes towards locally developed evidence-based treatment guidelines. METHODS: Three focus group interviews were performed with a total of 17 GPs working at both public and private primary health care centres in Skåne in southern Sweden. Transcripts were analysed by conventional content analysis. Codes, categories and themes were derived from data during the analysis. RESULTS: We found two main themes: GP-related influencing factors and External influencing factors. The first theme emerged when we put together four main categories: Expectations and perceptions about existing local guidelines, Knowledge about evidence-based prescribing, Trust in development of guidelines, and Beliefs about adherence to guidelines. The second theme included the categories Patient-related aspects, Drug industry-related aspects, and Health economic aspects. The time-saving aspect, trust in evidence-based market-neutral guidelines and patient safety were described as key motivating factors for adherence. Patient safety was reported to be more important than adherence to guidelines or maintaining a good patient-doctor relationship. Cost containment was perceived both as a motivating factor and a barrier for adherence to guidelines. GPs expressed concerns about difficulties with adherence to guidelines when managing patients with drugs from other prescribers. GPs experienced a lack of time to self-inform and difficulties managing direct-to-consumer drug industry information. CONCLUSIONS: Patient safety, trust in development of evidence-based recommendations, the patient-doctor encounter and cost containment were found to be key factors in GPs' prescribing. Future studies should explore the need for transparency in forming and implementing guidelines, which might potentially increase adherence to evidence-based treatment guidelines in primary care.

Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care.

BACKGROUND: Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged ≥75 years and who were using a multi-dose drug dispensing system. METHODS: Data were collected from the patients' electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. RESULTS: The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. CONCLUSIONS: Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.

Theory-based interventions to reduce prescription of antibiotics--a randomized controlled trial in Sweden.

BACKGROUND: Upper respiratory tract infections (URTIs) are the most common reason for consulting a GP and for receiving an antibiotic prescription, although evidence shows poor benefit but rather increasing antibiotic resistance. Interventions addressing physicians have to take into consideration the complexity of prescribing behaviour. OBJECTIVE: To study whether interventions based on behavioural theories can reduce the prescribing of antibiotics against URTIs in primary care. Setting and subjects. GPs at 19 public primary health care centres in southern Sweden. METHODS: We performed a randomized controlled study using two behavioural theory-based interventions, the persuasive communication intervention (PCI) and the graded task intervention (GTI), which emerged from social cognitive theory and operant learning theory. GPs were randomized to a control group or one of two intervention groups (PCI and GTI). MAIN OUTCOME MEASURES: Changes in the rate of prescription of antibiotics against URTIs in primary care patients of all ages and in patients aged 0-6 years. RESULTS: No significant differences were seen in the prescription rates before and after the interventions when patients of all ages were analysed together. However, for patients aged 0-6 years, there was a significant lower prescription rate in the PCI group (P = 0.037), but not the GTI group, after intervention. CONCLUSION: Theory-based interventions have limited impact on reducing the prescription of antibiotics against URTIs in primary care. Future studies are needed to draw firm conclusions about their effects.

Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study.

BACKGROUND: Polypharmacy in the Swedish elderly population is currently a prioritised area of research with a focus on reducing the use of potentially inappropriate medications (PIMs). Multi-professional interventions have previously been tested for their ability to improve drug therapy in frail elderly patients. OBJECTIVE: This study aimed to assess a structured model for pharmacist-led medication reviews in primary health care in southern Sweden and to measure its effects on numbers of patients with PIMs (using the definition of the Swedish National Board of Health and Welfare) using ≥10 drugs and using ≥3 psychotropics. METHODS: This study was a randomised controlled clinical trial performed in a group of patients aged ≥75 years and living in nursing homes or the community and receiving municipal health care. Medication reviews were performed by trained clinical pharmacists based on nurse-initiated symptom assessments with team-based or distance feedback to the physician. Data were collected from the patients' electronic medication lists and medical records at baseline and 2 months after the medication review. RESULTS: A total of 369 patients were included: 182 in the intervention group and 187 in the control group. One-third of the patients in both groups had at least one PIM at baseline. Two months after the medication reviews, the number of intervention group patients with at least one PIM and the number of intervention group patients using ten or more drugs had decreased (p = 0.007 and p = 0.001, respectively), while there were no statistically significant changes in the control patients. No changes were seen in the number of patients using three or more psychotropic drugs, although the dosages of these drugs tended to decrease. Drug-related problems (DRPs) were identified in 93 % of the 182 patients in the intervention group. In total, there were 431 DRPs in the intervention group (a mean of 2.5 DRPs per patient, range 0-9, SD 1.5 at 95 % CI) and 16 % of the DRPs were related to PIMs. CONCLUSIONS: Medication reviews involving pharmacists in primary health care appear to be a feasible method to reduce the number of patients with PIMs, thus improving the quality of pharmacotherapy in elderly patients.

Non-prescription medicines for pain and fever--a comparison of recommendations and counseling from staff in pharmacy and general sales stores.

OBJECTIVES: The purpose of this study is to map and analyze the content and quality of the encounter when customers buy non-prescription medicines for pain and fever. METHODS: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A "Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366 units were selected for each scenario. There were in total 625 observers: 208 in the child with fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancy scenario. DATA COLLECTION: 21st September to 20th November 2011. RESULTS: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnant woman. The staff suggested in 9% of the visits a medicine that is inappropriate in late pregnancy. The corresponding percentage in pharmacies was 1%. Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies to a feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the age of the child. General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid product when an acetaminophen preparation was requested. The corresponding percentage in the pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product. CONCLUSIONS: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneity of painkillers, which lead to inappropriate recommendations.

A retrospective analysis of drug-related problems documented in a national database.

BACKGROUND: Numerous patients are subject to drug-related problems (DRPs) every day, resulting in sub-optimal therapy, suffering and decreased quality of life, as well as in high societal health care costs. Classifying DRPs is important for the development of counselling skills and for pharmaceutical care practice and research, including assessments of the value of pharmacists' clinical interventions. Pharmacy practitioners have also reported to become more attentive to patients' drug-related needs, when requested to document their clinical interventions. Several studies have been conducted on DRPs, but there is still a need for a more thorough knowledge about their nature and the reasons for their occurrence. To examine DRP characteristics and causes by retrospectively analysing data and patient case histories, as documented by pharmacy practitioners in the Swedish national DRP database. SETTING: Community pharmacy based patient documentation, entered into the Swedish national DRP database. METHOD: Documented DRPs, clinical interventions and patient data were retrospectively examined and analysed. Particular attention was paid to case history reports in free text fields. Only reports containing adequate information for analysis and actual, correctly categorised DRPs were included. MAIN OUTCOME MEASURE: Subdivided DRP characteristics and causes. RESULTS: Both similarities and differences between DRP subclasses of prescription patients (n = 5,571) and OTC drug consumers (n = 2,894) were observed. Most DRP categories could be subdivided into at least three subclasses, according to their characteristics. Causes of DRPs could be extracted from free text field reports in four prescription DRP categories and three OTC DRP categories. Uncertainty about the aim of the drug was commonly characterised by a lack of knowledge about the indication in prescription patients and in an inappropriate drug selection in OTC drug consumers. A switch from a brand-name drug to a generic drug or from one generic to another was the cause in half of the therapy failures, which in turn was a frequent reason for overuse of drug. CONCLUSION: The study demonstrates the multi-facetted drug-related problems in patients and confirms the importance of attention by pharmacy practitioners for the detection of and intervention for DRPs.

GPs' views on patient drug use and the pharmacist's role in DRP management.

OBJECTIVE: The aim of this study was to examine general practitioners' (GPs') views on (1) patients' drug-related problems (DRPs) and noncompliance and (2) the role of pharmacy practitioners in DRP management. METHOD: A brief questionnaire was designed and distributed to 224 GPs in Sweden. RESULTS: Totally 152 GPs responded (68%). Most felt that pharmacy practitioners could improve patients' drug use by identifying DRPs. A majority of the GPs also found presentations and analyses of their local pharmacies' DRP documentation valuable. According to the GPs' experiences, adverse drug effects and therapy failure were the most salient problems in patients' drug use. Half of the doctors believed that 50-75% of their patients were compliant with their prescribed drug treatments. A majority of the GPs found a 75-95% degree of compliance acceptable. CONCLUSION: The surveyed GPs demonstrated very positive attitudes towards the role of pharmacy practitioners in improving patients' drug use and managing DRPs. The GPs realised that many patients were not compliant with their prescribed drug treatments and accepted an imperfect compliance.

Drug related problems after discharge from an Australian teaching hospital.

OBJECTIVE: To reconcile patients' medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. SETTING: Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. METHOD: This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. MAIN OUTCOME MEASURES: Number, type, distribution and international classification of drugs, diseases and drug-related problems. RESULTS: Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 ± SD 3.3 (range 3-19); in GP referrals: 8.9 ± SD 4.3 (range 2-23); and in HMR reports: 10.8 ± SD 4.0 (range 3-24). Mean number of diseases per patient in discharge summaries: 4.1 ± SD 2.9 (range 1-11); and in HMR reports: 4.7 ± SD 2.6 (range 1-12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 ± SD 4.3 problems (range 1-21). The most frequently recorded problems were the patients' uncertainty about drug aim: n = 128 (32.0%); potential interactions n = 89 (22.4%); and adverse reactions n = 60 (15.1%). CONCLUSION: This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients' uncertainly about their drugs and their diverse range of co-morbidities indicated the need for timely counselling by pharmacists in the community.

Provision of pharmaceutical care by community pharmacists: a comparison across Europe.

OBJECTIVE: To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. METHODS: A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). RESULTS: Response rates ranged from 10-71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. CONCLUSION: The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems.

BACKGROUND AND OBJECTIVE: Due to drug-related problems (DRPs) that cause both unnecessary suffering and huge costs to society, many patients do not receive the intended beneficial effects of their treatment. Pharmacy practitioners have a key responsibility to respond to these problems, but more knowledge about the expected outcomes of their interventions is needed. The objective of the study was to assess the clinical and economic outcomes of community pharmacy interventions in patient DRPs. METHODS: Drug-related problems in 13 different patient groups were identified and classified, according to the Westerlund System, by pharmacy practitioners from 89 Swedish pharmacies in 2006. The cases were documented in the pharmacy software and transferred to the national DRP database. An assessment model was developed and applied by the researchers (a pharmacist and a physician). This assessment was used to conduct a retrospective review by analysing the DRP and intervention documentation, in particular case descriptions from free text fields. Expected clinical patient outcomes of pharmacy interventions were judged in terms of improved therapeutic effects and prevented or relieved adverse drug reactions (ADRs). The review also assessed the expected patient outcomes with regard to initiated or avoided primary care contacts or avoided hospitalisations. The resulting hypothetically avoided direct societal costs and the estimated pharmacy personnel costs were calculated for the study and extrapolated to the Swedish nationwide level on an annual basis, to demonstrate the potential of national cost savings by pharmacy DRP-interventions. RESULTS AND DISCUSSION: In 358 cases (68%), the pharmacy interventions were judged to have produced an improved therapeutic effect in the patient, and in 172 cases (32%) to have prevented or relieved ADRs. Primary care contacts were initiated for 151 patients (29%), and pharmacy interventions were assessed to have saved 68 (13%) primary care contacts and 16 (3%) future hospitalisations. The potential societal cost savings extrapolated to Sweden at the national level were estimated at euro 358 million. This is 37 times the expected pharmacy personnel costs for identifying and responding to the DRPs. CONCLUSION: Our study demonstrates that community pharmacy interventions in patient DRPs are most likely to lead to favourable clinical and economic outcomes. The convincing cost-benefit ratio should be presented to health care politicians and decision makers to encourage appropriate remuneration for these services.