Tasaka Yuichi, Tanaka Akihiro, Yasunaga Daiki, Asakawa Takashige, Araki Hiroaki, Tanaka Mamoru
1Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295 Japan.
Ehime Society of Hospital Pharmacists, 454 Shitsukawa, Toon, Ehime 791-0295 Japan.
J Pharm Health Care Sci. 2018 Dec 13;4:33. doi: 10.1186/s40780-018-0125-z. eCollection 2018.
Pharmaceutical intervention enables safe and effective pharmacotherapy by avoiding of adverse drug reactions (ADRs) and efficacy attenuations. Many prescriptions require optimization, and pharmaceutical interventions are inextricably associated with the prevention of potential drug-related problems (DRPs). Although the analysis and understanding of pharmaceutical interventions can lead to improvement in prescription, the analysis of routine pharmaceutical interventions in Japan in insufficient. Thus, we conducted this study to understand potential DRPs by analyzing routine pharmaceutical interventions made by pharmacists in Japan.
Pharmacists register the details of pharmaceutical interventions (excluding personal patient information) in a web-based database. We classified data of pharmaceutical interventions into 13 DRP types, 43 DRP subtypes, and 10 intervention categories (e.g., avoidance of serious ADRs and renal dosing recommendations). These data were analyzed with a focus on renal dysfunction and polypharmacy.
During the study period, 2376 pharmaceutical interventions were performed. Overall, 68.2% of pharmaceutical interventions were for patients aged over 65 years. The most frequently detected potential DRP was overdosage, followed by omission of prescription, contraindications, and duplication of a drug with similar effect. The main cause of contraindication and overdosage was renal function deterioration, and that of polypharmacy was duplication of a drug with similar effect. Using our original evidence-based approach, we found that 2376 pharmaceutical interventions prevented ADRs for 1678 drugs, with potential cost savings of up to USD 2,657,820.
Our results indicate that the analysis of routine pharmaceutical interventions is beneficial for detecting potential DRPs. Our findings also show that, in an aging society, pharmacists have an important role in providing medication safety, with potential cost savings.
药物干预通过避免药物不良反应（ADR）和疗效减弱实现安全有效的药物治疗。许多处方需要优化，药物干预与预防潜在药物相关问题（DRP）密切相关。尽管对药物干预的分析和理解有助于改善处方，但日本对常规药物干预的分析不足。因此，我们开展本研究，通过分析日本药剂师进行的常规药物干预来了解潜在的DRP。
药剂师在基于网络的数据库中记录药物干预的详细信息（不包括患者个人信息）。我们将药物干预数据分为13种DRP类型、43种DRP亚型和10种干预类别（如避免严重ADR和肾脏给药建议）。重点针对肾功能不全和多重用药对这些数据进行分析。
在研究期间，共进行了2376次药物干预。总体而言，68.2%的药物干预针对65岁以上患者。最常检测到的潜在DRP是用药过量，其次是处方遗漏、禁忌证以及作用相似药物的重复使用。禁忌证和用药过量的主要原因是肾功能恶化，多重用药的主要原因是作用相似药物的重复使用。使用我们基于证据的原始方法，我们发现2376次药物干预预防了1678种药物的ADR，潜在成本节省高达2657820美元。
我们的结果表明，对常规药物干预进行分析有助于检测潜在的DRP。我们的研究结果还表明，在老龄化社会中，药剂师在保障用药安全方面发挥着重要作用，同时具有潜在的成本节省效益。
