Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care.
2019
Objective. To evaluate the process of clinical medication review for elderly patients with
polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim
was to identify the number and type of drug therapy problems and to assess how and to what
extent drug therapy problems were actually solved.
Method. An observational cross-sectional study, conducted in nine general practices in the
Netherlands between June 2014 and June 2015. On three pre-set dates, the non-dispensing
pharmacists completed an online data form about the last 10 patients who completed all stages
of clinical medication review. Outcomes were the type and number of drug therapy problems,
the extent to which recommendations were implemented and the percentage of drug therapy
problems that were eventually solved. Interventions were divided as either preventive (aimed at
following prophylactic guidelines) or corrective (aimed at active patient problems).
Results. In total, 1292 drug therapy problems were identified among 270 patients, with a median
of 5 (interquartile range 3) drug therapy problems per patient, mainly related to overtreatment
(24%) and undertreatment (21%). The non-dispensing pharmacists most frequently recommended
to stop medication (32%). Overall, 83% of the proposed recommendations were implemented;
57% were preventive, and 35% were corrective interventions (8% could not be assessed). Almost
two-third (64%) of the corrective interventions actually solved the drug therapy problem.
Conclusion. Non-dispensing pharmacists integrated in general practice identified a large number
of drug therapy problems and successfully implemented a proportionally high number of
recommendations that solved the majority of drug therapy problems
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