Abstract
Background Preventable drug-related morbidity (PDRM) arising in the community is a problem of unacceptable magnitude. Effective interventions to reduce this problem will avoid unnecessary patient harm and waste of resources for the health care system. Objective To develop and pilot an intervention to manage the risk of PDRM in community pharmacy, underpinned by validated PDRM indicators. Setting Portuguese community pharmacy. Method Our work was informed by the Medical Research Council framework for the development and evaluation of complex interventions. Human error theory was considered as a theoretical framework for developing the intervention. Additionally, this stage consisted of a literature review, followed by two focus groups (17 community pharmacists) and interviews with 8 professional leaders. A 4-component intervention, was developed: (1) operationalisation of 4 validated PDRM indicators in dispensing encounters (‘dispensing’ indicators), and operationalisation of 25 validated indicators in patients enrolled in pharmaceutical care programmes (‘follow-up’ indicators), (2) pharmacist resource pack, (3) pharmacists’ training and (4) support scheme. Piloting consisted of a feasibility study in 15 community pharmacies and an acceptability study with participating pharmacists (n = 16). Main outcome measures Proportion of cases with counselling (dispensing indicators); proportion of cases assessable, proportion of cases at risk and proportion of cases with risk minimisation actions (follow-up indicators). Results Operationalization of dispensing indicators resulted in counselling in 44.1 % of cases (n = 666). Factors influencing acceptability included pharmacists’ perceptions of patients’ characteristics, interest and informational needs, as well as perceptions on the relevance of safety information. For follow-up indicators, data were available to assess most cases (93/105, 88.6 %). About half of the assessable cases were at risk of a PDRM event (n = 49; 51.6 %); pharmacists undertook risk minimization actions in 23 cases (46.9 %). Lack of time and inter-professional issues emerged as important factors influencing acceptability. Conclusions A novel risk management intervention was developed. Feasibility and acceptability of the 4-component intervention in Portuguese community pharmacy provided ‘proof of concept’, whilst highlighting aspects that need further refinement to better measure and maximise efficacy in future evaluative research.
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References
Goettler M, Schneeweiss S, Hasford J. Adverse drug reaction monitoring—cost and benefit considerations. Part II: cost and preventability of adverse drug reactions leading to hospital admission. Pharmacoepidemiol Drug Saf. 1997;6(Suppl 3):S79–90.
Muehlberger N, Schneeweiss S, Hasford J. Adverse drug reaction monitoring—cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admissions. Pharmacoepidemiol Drug Saf. 1997;6(Suppl 3):S71–7.
Beijer HJM, De Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.
Alonso HP, Otero Lopez MJ, Maderuelo Fernandez JA. Ingresos hospitalarios causados por medicamentos: incidencia, características y coste [Spanish: Drug-induced hospital admissions: Incidence, characteristics and cost]. Farm Hosp. 2002;26(2):77–89.
Winterstein AG, Sauer BC, Hepler CD, Poole C. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36(7–8):1238–48.
Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, et al. Which drugs cause preventable hospital admissions to hospital? A systematic review. Br J Clin Pharmacol. 2006;63(2):136–47.
MacKinnon NJ, Hepler CD. Preventable drug-related morbidity in older adults—1. Indicator development. JMCP. 2002;8(5):365–70.
MacKinnon NJ, Hepler CD. Preventable drug-related morbidity in older adults—2. Use within a managed care organisation. JMCP. 2003;9(2):134–41.
Sauer BC, Hepler CD, Cherney B, Williamson J. Computerized Indicators of Potential Drug-related Emergency Department and Hospital Admissions. Am J Manag Care. 2007;13:29–35.
Morris CJ, Cantrill JA, Hepler CD, Noyce PR. Preventing drug-related morbidity—determining valid indicators. Int J Qual Health Care. 2002;14(3):183–98.
Morris CJ, Cantrill JA. Preventing drug-related morbidity—the development of quality indicators. J Clin Pharm Ther. 2003;28(4):295–305.
Hammersley VS, Morris CJ, Rodgers S, Cantrill JA, Avery AJ. Applying preventable drug-related morbidity indicators to the electronic patient record in UK primary care: methodological development. J Clin Pharm Ther. 2006;31(3):223–9.
Morris CJ, Cantrill CA, Bates JR. How the use of preventable drug-related morbidity indicators can improve medicines management in primary care. Pharm J. 2003;271:682–6.
Morris CJ, Rodgers S, Hammersley VS, Avery AJ, Cantrill JA. Indicators for preventable drug related morbidity: application in primary care. Qual Saf Health Care. 2004;13(3):181–5.
Morris CJ, Cantrill JA, Avery AJ, Howard RL. Preventing drug related morbidity: a process for facilitating changes in practice. Qual Saf Health Care. 2006;15(2):116–21.
Robertson HA, MacKinnon NJ. Development of a list of consensus-approved clinical indicators of preventable drug-related morbidity in older adults. Clin Ther. 2002;24(10):1595–613.
Flanagan PS, MacKinnon NJ, Bowles SK, Kirkland SA. Validation of four clinical indicators of preventable drug-related morbidity. Ann Pharmacother. 2004;38(1):20–4.
Guerreiro MP, Cantrill JA, Martins AP. Preventable drug related morbidity—determining valid indicators for primary care in Portugal. Acta Med Port. 2007;20:107–30.
Dago AM, Arcos PG, Álvarez de Toledo FS, Baena MIP, Martínez JO, Gorostiza IO. Indicadores de riesgo de morbilidad prevenible causada por medicamentos [Spanish: Indicators of preventable drug related morbidity]. Gac Sanit. 2007; 21(1):29–36.
Gianino MM, Foti G, Borghese R, Lorelli S, Siliquini R, Renga G. Indicators for preventable drug-related morbidity. Practical application in home-based care. Pharmacoepidemiol Drug Saf. 2008;17:501–10.
Medical Research Council. A framework for the development and evaluation of RCTs for complex interventions to improve health. London: MRC; 2000.
Campbell M, Fitzpatrick R, Haynes A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321:694–6.
Watson MC. Using the Medical Research Council (UK) framework for the development and evaluation of randomised controlled trials for complex interventions to improve health [editorial]. Int J Pharm Pract. 2006;14:233–4.
Wong ICK. Randomised controlled trials (RCTs) to evaluate complex healthcare interventions—a case study. Pharm World Sci. 2004;26:247–52.
Reason J. Human error: models and management. BMJ. 2000;320:768–70.
Hepler CD, Segal R. Preventing medication errors and improving drug therapy outcomes. Boca Raton: CRC Press; 2003.
Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev. 2000;(2). doi:10.1002/14651858.CD000336.
Roberts A (ed.). Business and professional facilitators. University of Sydney. Final report, 2003.
Tully MP, Seston EM, Cantrill JA. Motivators and barriers to the implementation of pharmacist-run prescription monitoring and review services in two settings. Int J Pharm Pract. 2000;8:188–97.
Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ. 2000;320:114–6.
Paulino EI, Guerreiro MP, Cantrill JA, Martins AP, Costa FA, Benrimoj SI. Community pharmacists’ and physicians’ inter-professional work—insights from qualitative studies with multiple stakeholders. Rev Port Clin Geral. 2010;26:590–606.
Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:979–83.
Martins AP, Miranda AC, Mendes Z, Soares MA, Ferreira P, Nogueira A. Self-medication in a Portuguese urban population: a prevalence study. Pharmacoepidemiol Drug Saf. 2002;11:409–14.
Hughes CM, McCann S. Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment. Br J Gen Pract. 2003;53:600–6.
Reebye RN, Avery A, Van Den Bosch WJHM, Aslam M, Nijholt A, Van Der Bij A. Exploring community pharmacists’ perceptions of their professional relationships with physicians, in Canada and The Netherlands. Int J Pharm Pract. 1999;7:158.
Edmunds J, Calnan MW. The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and general practitioners in the United Kingdom. Soc Sci Med. 2001;53:943–55.
Acknowledgments
The list of people that contributed to this research over the course of almost 4 years is very long, which makes it impossible to name them. We are, however, deeply grateful for their contribution to the execution of the work. A special thank you goes to research participants, without whom this would not have been possible. Community pharmacies in the feasibility study accommodated study requirements throughout 8 months, which is especially commendable.
Funding
This work was supported by The University of Manchester (UK) as part of a PhD programme and the Centre for Health Evaluation & Research, National Association of Pharmacies group (Portugal).
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Pereira Guerreiro, M., Martins, A.P. & Cantrill, J.A. Preventable drug-related morbidity in community pharmacy: development and piloting of a complex intervention. Int J Clin Pharm 34, 699–709 (2012). https://doi.org/10.1007/s11096-012-9625-3
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DOI: https://doi.org/10.1007/s11096-012-9625-3