Keywords • Clinical Pharmacists • Pharmaconomists • Drug-related Problems

Background Drug-Related Problems (DRPs) are factors for Adverse Drug Events. Two approaches for identifying and intervening on DRPs are the use of clinical pharmacists and pharmaconomists services.

Purpose To investigate the number, type and severity of DRPs identified by pharmaconomists conducting a prescription review and clinical pharmacists conducting a medication review, respectively. Furthermore, to estimate the resource consumption related to the services.

Methods A non-randomised controlled study with two interventions, Pharmaconomist Medicine Management (PMM) and Clinical Pharmacist Service (CPS), and one baseline took place on a rural non-university hospital on eight bed-units. Newly admitted patients were included on weekdays between 7.30 and 9.00. CPS consisted of a medication review based on the electronic medical journal. PMM consisted of a prescription review during the Medicine Management Service on the wards. The baseline review was conducted using only the Regional Drugs and Therapeutics Committee recommendations and the wards Hospital Formulary. Primary outcome: Number, type and severity of DRPs. The type of DRPs were classified using the PCNE classification. The severity of the DRPs were assessed using Dutton et al.¹ classification ranging from S.5-S.1, the latter being the most severe. Secondary outcome: Time use and cost per patient.

Results In 3 weeks, 157 patients were included. In total 515 DRPs were identified. There was no significant statistic difference between the number of DRPs identified by CPS and PMM. The type of DRPs were statistically significant across all groups. The most frequent problem identified by PMM and CPS were related to cost-effectiveness and treatment effectiveness, respectively, accounting for more than half of all DRPs. The severity of the DRPs identified by CPS was significantly higher than DRPs identified by PMM. The average time consumption was 1.7 (±1.9) min., for PMM and 12.1 (±8.7) min. for CPS.

Conclusions PMM mainly identify DRPs related to costs effectiveness, whereas CPS mainly identify DRPs related to treatment effectiveness. Both services find significantly different and more severe DRPs compared to baseline. A CP medication review costs almost 10 times more than a PMM prescription review; however, CPs identify 3 times more severe DRPs.

1. Dutton K, Hedger N, Wills S, Davies P. Prevent medication errors on admission. Clinical Governance: An Intl J. 2003 Jun 1;8(2):128–37.