Comparing 4 classification systems for drug-related problems: Processes and functions

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Abstract

Background

Counseling patients on drug-related problems (DRPs) is a new enterprise for pharmacists. Accordingly, a variety of classification systems have been created to document DRPs. This aroused our interest in finding out how classification systems differ.

Objective

The objective is to explore and describe the characteristics of 4 classification systems for DRPs to understand their similarities and differences with regard to processes and functions.

Methods

Four established classification systems were selected; they were Strand, Granada-II, Pharmaceutical Care Network Europe v5.0, and Apoteket. To gain experience of the use of the systems, an existing database containing documented problems that were identified during patient counseling at community pharmacies was used. The entries in the database were classified using the 4 selected classification systems, one at a time. In the following analysis, focus was set on what issues were classified and how they were classified in each system. Based on similarities and differences, 8 themes were identified and characteristics of the 4 systems were listed according to these themes. Characteristics of each system were thoroughly scrutinized and interpreted.

Results

The processes of selecting classification categories were different in all 4 systems, and as a result the contents of categories in systems were different. The systems had different characteristics and a decisive characteristic was whether the patients were involved in the classification of problems or not. Because of the different characteristics the systems had different functions.

Conclusions

To understand the usefulness of a classification system, both structure of categories and work process must be considered. The studied systems had different functions that revealed different aims embedded in the systems. To develop the counseling role of pharmacists, a limited number of classification systems would be beneficial. To get there, common aims and common systems must be developed.

Introduction

The documentation of drug-related problems (DRPs) is regarded as an essential component of pharmaceutical care.1 A good classification system can serve both as a guideline for the pharmacist counseling a patient and as a means of documenting the results of the counseling. However, a search in Medline revealed that several classification systems for DRPs have been proposed, suggesting a lack of agreement concerning both definitions of DRPs and their classification.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 This can probably be explained by the fact that the activity of counseling patients is a new enterprise for pharmacists. Consequently, many pharmacists are working to find the best practice and to create tools that support their way of practicing. As a result, a variety of different definitions, practices, and tools emerge. In a developing phase like this, it is valuable to describe the various expressions of practitioners' work to increase the understanding of what is going on. Against this background, we were interested to find out how classification systems differ. Previous comparative reviews have focused mainly on the structure of systems.14 In this study, we focus on the processes and functions of systems.

Section snippets

Aim

This study aims at exploring and describing the characteristics of 4 classification systems for DRPs to understand their similarities and differences with regard to processes and functions.

General methodological problems

The task of comparing different DRP classification systems is connected to major methodological difficulties. The reason for this is that the systems as such must be used in order to be able to explore the processes and functions of the systems. It is not sufficient to study the various categories and the instructions of a system; the experience of the actual use of the system is a key factor in the exploration. This means that when different systems are to be explored and compared (which was

Results

The results of the analysis are presented in Table 3, wherein the identified 8 themes and related characteristics of each system are listed. From the patterns that emerged, an overall function of the systems were identified. The overall functions were:

  • Strand: To help patients achieve their desired drug-related outcomes

  • Granada-II: To identify clinical outcomes of patients' drug therapy

  • PCNE: To identify drug-related events known to lead to harm or jeopardize outcome

  • Apoteket: To help patients use

Discussion

This is, to our knowledge, the first study that compares classification systems for DRPs and analyzes characteristics in relation to processes and functions. Previous reviews have acknowledged that different classification systems have different structures.14 However, by focusing on the processes of the systems new knowledge was gained. The process as such can be understood as a cognitive map to classify a problem and this process has a profound impact on the result. The exploration revealed

Conclusion

The classification systems for DRPs examined in this study are different, not only in structure but also in cognitive process, which thus influences the outcome of the classification. Two important characteristics that separated the studied systems were whether the patient participated in the classification of the problems and whether process-related issues were classified. Because the systems have different characteristics, their overall functions are different. The way a system functions is

Acknowledgments

The authors are most grateful to Dr. Foppe van Mil for valuable comments on previous versions of this paper. The study was supported by the National Corporation of Swedish Pharmacies (Apoteket AB). A grant was received from The Swedish Academy of Pharmaceutical Sciences (Apotekarsocieteten).

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