A Retrospective Analysis of Drug-related Problems Documented in a National Database

Background: Numerous patients are subject to drug-related problems (DRPs) every day, resulting in sub-optimal therapy, suffering and decreased quality of life, as well as in high societal health care costs. Classifying DRPs is important for the development of counselling skills and for pharmaceutical care practice and research, including assessments of the value of pharmacists' clinical interventions. Pharmacy practitioners have also reported to become more attentive to patients' drug-related needs, when requested to document their clinical interventions. Several studies have been conducted on DRPs, but there is still a need for a more thorough knowledge about their nature and the reasons for their occurrence. To examine DRP characteristics and causes by retrospectively analysing data and patient case histories, as documented by pharmacy practitioners in the Swedish national DRP database.

Setting: Community pharmacy based patient documentation, entered into the Swedish national DRP database.

Method: Documented DRPs, clinical interventions and patient data were retrospectively examined and analysed. Particular attention was paid to case history reports in free text fields. Only reports containing adequate information for analysis and actual, correctly categorised DRPs were included.

Main Outcome Measure: Subdivided DRP characteristics and causes.

Results: Both similarities and differences between DRP subclasses of prescription patients (n = 5,571) and OTC drug consumers (n = 2,894) were observed. Most DRP categories could be subdivided into at least three subclasses, according to their characteristics. Causes of DRPs could be extracted from free text field reports in four prescription DRP categories and three OTC DRP categories. Uncertainty about the aim of the drug was commonly characterised by a lack of knowledge about the indication in prescription patients and in an inappropriate drug selection in OTC drug consumers. A switch from a brand-name drug to a generic drug or from one generic to another was the cause in half of the therapy failures, which in turn was a frequent reason for overuse of drug.

Conclusion: The study demonstrates the multi-facetted drug-related problems in patients and confirms the importance of attention by pharmacy practitioners for the detection of and intervention for DRPs.