Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
J Clin Pharm Ther. 2022 Jul;47(7):964-972. doi: 10.1111/jcpt.13628. Epub 2022 Feb 26.
Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients' adherence to the clinical pharmacist interventions as well as the physicians' acceptance of these recommendations.
This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18 years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations.
Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p = 0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient's compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%.
The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients' confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.
药物疗法是治疗许多医学病症（尤其是慢性病）的重要策略，通常涉及同时使用多种药物。增加药物的使用可能会对安全有效的药物治疗带来一些挑战，如果不被药剂师发现并加以预防，最终可能会导致药物相关问题（DRP）。本研究旨在检查伊朗患者的 DRP 发生率，并评估患者对临床药师干预措施的依从性以及医生对这些建议的接受程度。
这项研究是在大学附属的门诊药物治疗诊所进行的，为期 22 个月。研究对象为年龄在 18 岁及以上，患有至少一种慢性病并服用至少四种药物的患者。临床药师对患者进行全面的药物评估。使用 DOCUMENT 分类系统确定 DRP。临床药师提供建议，包括针对患者和/或医生的干预措施，以解决 DRP。在两周后对患者进行随访，以评估其对临床药师建议的依从性和医生的接受程度。
本研究共纳入 200 名患者。总体而言，共发现 875 例 DRP，平均每位患者 4.37 例。最常见的 DRP 与患者教育或信息（22.8%）、治疗不足的指征（17.4%）和患者依从性（17.2%）有关。与 DRP 相关的最常见药物是营养代谢类药物（占 22.2%），其次是心血管系统药物（19.2%）和神经系统药物（9.6%）。DRP 的发生率仅与性别有关，女性更高（p=0.019）。临床药师共提供 912 项干预措施，平均每位患者和每例 DRP 分别提供 4.56 项和 1.04 项干预措施。患者教育（41.3%）、药物起始或停药（24.5%）和非药物干预（12.9%）是最常见的临床药师干预措施。在 912 项干预措施中，有 665 项得到了随访，其中 427 项与患者相关，228 项涉及医生。患者对临床药师建议的依从性为 81.2%。医生对建议的接受率为 44.1%。
研究表明，特别是由临床药师运营的药物治疗诊所等专门设计的服务对于以有效的方式检测和解决 DRP 是必要的。患者对临床药师服务的高依从性表明患者对药物治疗诊所提供的服务充满信心。医生对建议的低接受率突出了需要改善门诊环境中临床药师与医生之间的专业合作。
