Survey of Drug-Related Problems Identified by Community Pharmacies
Background: A drug-related problem (DRP) is defined as an event or circumstance that actually or potentially interferes with desired health outcomes. DRPs can lead to ineffective pharmacotherapy and may cause drug-related morbidity and mortality. Most DRPs are avoidable and community pharmacies are assuming an active role in preventing and solving DRPs.
Objective: To identify the spectrum of DRPs encountered in community pharmacies.
Methods: In 2005, a nationwide survey in Germany was conducted in community pharmacies to record all identified DRPs. Participating community pharmacies were free to select one week within the designated study period (February-May) and were instructed to record basic statistics (eg, number of patient interactions, number of prescriptions filled/nonprescription [over-the-counter; OTC] drugs dispensed per week), as well as patient-, problem-, and intervention-related data (eg, patient age and sex, whether a prescription-only or OTC drug was involved in the DRP, the time needed for problem resolution). DRPs were categorized using a modified version of the PI-Doc (problem-intervention-documentation) classification system.
Results: Community pharmacies that participated in the study (N = 1146) documented 10,427 DRPs (9.1 DRP per pharmacy per week). A broad spectrum of DRPs was identified, with 9 of 10 cases involving prescribed medicines. DRPs arose on 3 primary levels: the prescription-, the patient-, and the delivery level. Overall, drug-drug interactions were the most frequently reported DRP (8.6%) and, according to community pharmacies, more than 80% of identified DRPs could be resolved completely. The prescribing physician was contacted in 60.5% of all such cases. Median time needed for solving a DRP was 5 minutes.
Conclusions: Pharmacists in the community pharmacy setting are well suited to identify and resolve DRPs. Ensuring the proper use of both prescription and OTC drugs is one of the basic responsibilities of pharmacists. This specific role of pharmacists within the healthcare system needs to be more fully recognized.

Demographic and socioeconomic elements continue to exert increasing pressure on healthcare systems to develop new strategies for the efficient use of available healthcare resources. Savings plans that are expedient but do not diminish the quality of patient care are needed. In most countries, spending on prescription drugs is one of the most cost-intensive considerations for health insurance companies, with escalating costs driven by the aging population, the growing number of people with chronic diseases, and the availability of new and expensive medications.

Drug-related problems (DRPs) such as inappropriate prescription, clinically relevant drug-drug interactions, nonadherence, and adverse drug reactions are common. The corresponding economic impact incurred is quite extensive, with costs in the US estimated at $177 billion in 2000. In a review of international studies, it was found that as many as 28% of all emergency department visits were related to DRPs and as many as 24% resulted in hospital admission. It has been argued that up to 70% of these occurrences were avoidable. A follow-up analysis suggests that a considerable amount of direct healthcare costs could be saved by more fully using the competencies and skills of the pharmacist and provision of pharmaceutical care.

Pharmacists are highly educated and have a professional responsibility for the efficient counseling of patients to ensure safe and judicious use of medicines. Effective pharmacy practice thus plays a vital and proactive role in preventing and solving DRPs. Patient safety is ensured and the optimal effects of drug treatment are achieved by identifying, preventing, and solving potential complications; these processes are the core of pharmaceutical care. Bearing in mind the ever-changing political and social environment, in this context especially, the specific role of the pharmacist and pharmacy practice needs to be more clearly defined within the healthcare system.

To demonstrate the pharmacist's role in ensuring safe and efficient use of medicines in daily practice in the community pharmacy setting, the primary objective of this study was to identify the spectrum of DRPs dealt with in community pharmacies throughout Germany.