Abstract Objectives To investigate how a community pharmacist can affect the quality of repeat prescribing, and to develop a model for general practitioner (GP) and pharmacist co-operation. Methods Repeat prescriptions with three or more items were reviewed by a community pharmacist and randomly allocated to a trial or control group. Drug-related problems (DRPs) were discussed at joint meetings with the GP and the pharmacist. A modified Delphi technique was used to evaluate the clinical significance of the DRPs identified by the pharmacist. Setting The repeat prescription review and meetings took place in a GP surgery in an inner city location between November, 1995, and October, 1997. Key findings The pharmacist reviewed 511 repeat prescriptions, representing 3,018 prescribed items. Ninety repeat prescriptions (36.3 per cent) in the trial group and 86 repeat prescriptions (34.1 per cent) in the control group were identified as having DRPs. The GP agreed with 92.3 per cent of the interventions in the trial group, while only 12.8 per cent of the interventions in the control group were routinely resolved by the GP. The difference in interventions dealt with between the trial and the control group is statistically significant (X2=94.14, P<0.001). The absolute risk reduction (ARR) was 26 per cent, and the prescription number needed to treat (NNT) was 3.8. For every 19 prescriptions reviewed, an intervention that results, or potentially results, in clinical improvement in patient care was made by the pharmacist. Conclusion The pharmacist significantly reduced the number of DRPs associated with repeat prescriptions compared with routine surgery procedure. Pharmacist review of repeat prescriptions is an effective method of solving DRPs, reducing risk and making significant clinical improvements to patient care.
Background. Many consultations are partly or totally spent on minor ailments. A minor ailment is defined as a health complaint which, by simple actions, patients could handle themselves. Objective. To investigate the prevalence, type of conditions, and time spent on minor ailments in consultations in out-of-hours care in Norway. Design and setting. An observational study of consultations at six out-of-hours primary care centres was carried out during evenings and weekends in November and December 2008. Main outcome measures were number and type of minor ailments, as well as consultation time. The minor ailments were predefined by a list of conditions. Conditions which, by certain pre-set criteria, still needed a doctor's professional advice were reclassified as “no minor ailment”. Results. A total of 210 consultations were observed. The patients’ mean age was 28 years (range 0–94). Cough, fever, sore throat, upper respiratory tract infection, and earache contributed 76% of the 211 minor ailments registered. After reclassification, 58 (28%) of the 210 consultations registered were classified as partly or totally a minor ailment. These minor ailments represented 18% of the doctors’ total consultation time in the 210 observed consultations. Conclusion. More than a quarter of the observed consultations were partly or totally spent on addressing minor ailments. This shows a potential for empowering patients to rely on self-care also for minor ailments in out-of-hours primary care.
To establish the scope of harm related to medications, and thus design harm-reduction measures, healthcare organizations are required to measure medication safety events. This chapter will investigate methodologies for detecting adverse drug events and medication errors, analyze what type of events they detect, and discuss their advantages and limitations. We conducted a scoping review, and identified studies that compared at least two detection methods directly. The review resulted in 13 studies, of which ten were conducted in hospitals, and three were from the outpatient setting. Methods used to detect medication safety events were: incident reporting, record review, computerized surveillance, direct observation, and interviews. The detection rate of adverse drug events and medication errors varied substantially depending on the method. Incident reporting detected small numbers of events, but detected events that were not identified by other methods. Record review detected more adverse drug events than incident reporting, but missed whole classes of events, such as medication administration errors and omissions. Direct observation detected most medication errors. Computerized surveillance has promising detection abilities and can be less resource and time-intensive compared with record review, after the initial implementation. Small numbers of events were detected using any one method alone, that is, none of the methods can serve as a gold standard, and each method described has its place in monitoring medication safety. The literature supports a combination of methods to be used to detect adverse drug events and medication errors. The 10 studies in this scoping review that are from hospitals, are also described and discussed in the PhD thesis of the first author(Mulac, 2022). The scoping review, however, resulted in a low number of studies (n = 3) from the outpatient setting, which highlights the research and knowledge gaps of detecting methods for adverse drug events in municipal health and care services.
Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries. Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase. Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors ( n = 6), nurses ( n = 6), or pharmacists ( n = 3). The most common types of MAEIs were education ( n = 6), medication regimen management ( n = 5), and adherence monitoring feedback ( n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e. , implementation and persistence. Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.
