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OBJECTIVE: To detect the frequency of potential drug-drug interactions (DDIs) in an outpatient group of elderly people in 6 European countries, as well as to describe differences among countries. DATA SOURCES AND METHODS: Drug use data were collected from 1601 elderly persons living in 6 European countries. The study population participated in a controlled intervention study over 18 months investigating the impact of pharmaceutical care. Potential DDIs were studied using a computerized detection program. RESULTS: The elderly population used on average 7.0 drugs per person; 46% had at least 1 drug combination possibly leading to a DDI. On average, there were 0.83 potential DDIs per person. Almost 10% of the potential DDIs were classified to be avoided according to the Swedish interaction classification system, but nearly one-third of them were to be avoided only for predisposed patients. The risk of subtherapeutic effect as a result of a potential DDI was as common as the risk of adverse reactions. Furthermore, we found differences in the frequency and type of potential DDIs among the countries. CONCLUSIONS: Potential DDIs are common in elderly people using many drugs and are part of a normal drug regimen. Some combinations are likely to have negative effects; more attention must be focused on detecting and monitoring patients using such combinations. As differences in potential DDIs among countries were found, the reasons for this variability need to be explored in further studies.

Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.

Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.

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.

Keywords: Pharmaceutical care; Drug-related problems; Classification systems

Background: Different ways to practice pharmaceutical care have been developed. One expression of this fact is the existence of many different classification systems to document drug-related problems (DRPs). Evidence suggests that classification systems have different characteristics and that these characteristics reflect different conceptions of pharmaceutical care. To increase the understanding of conceptions of pharmaceutical care, underlying values and beliefs (ideologies) can be explored. Objective: To explore various conceptions of pharmaceutical care to identify the care ideologies on which these conceptions are based. Methods: Representatives of 4 selected conceptions of pharmaceutical care were interviewed in face-to-face meetings. During the interviews, 4 basic questions were asked. Three were focused on pharmaceutical care and 1 on DRPs. Interview transcripts were analyzed by an inductive method inspired by grounded theory. The conceptions studied were Strand, Granada-II, PCNE v5.0, and Apoteket. Results: In Strand, patients are given a more active role in the pharmaceutical care process, as compared to Granada-II, PCNE v5.0, and Apoteket. Pharmacists in all the conceptions of pharmaceutical care assume they have special knowledge that patients benefit from. However, they use their knowledge in different ways in the various pharmaceutical care conceptions. In Strand, individual goals of drug therapy are established together with the patient, whereas in Granada-II, PCNE, and Apoteket goals are not explicitly discussed. The identified differences correspond to different care ideologies. Conclusions: The pharmaceutical care conceptions are based on different care ideologies. The ideology is expressed in how therapy goals are set and patient needs defined. Strand is based on a patient-centered ideology; patient therapy goals and needs are defined by the patient together with the practitioners. Granada-II, PCNE, and Apoteket are based on an evidence-based medicine approach; patient therapy goals and needs are defined by the practitioners, based on available scientific knowledge.