Introduction
A Drug-related problem (DRP) has been defined as an event or
circumstance involving drug therapy that actually or potentially
interferes with desired health outcomes.1 DRPs occur
in different types and there are different classification systems.2,3 DRPs reduce the quality of life, cause morbidity
and mortality and thus cause significant economic costs and negative
effects for both the individual and society.4 Hence,
pharmacists’ identifications and resolutions of DRPs may result in both
positive clinical outcomes and large societal cost
savings.5
Identification, resolution and prevention of DRPs is one of the major
tasks by community pharmacists, as have been demonstrated by
studies.6-11 The use of electronic prescriptions has
long been fully implemented in Sweden. A governmentally owned clinical
decision support system (CDSS), named Electronic Expert Support (EES),
has been established, which analyses patients´ electronically stored
prescriptions in the Swedish national prescription repository. It was
developed according to the Drug Utilization Review (DUR) by Medco Health
Solutions, used in various forms at community pharmacies in the US, and
has been adapted to Swedish clinical practice.12,13The pharmacist can use the EES during dispensing prescriptions to
identify potential DRPs. With EES, the electronic prescription is
analyzed both individually and together with all the patient’s other
current prescriptions and alerts of potential DRPs and EES suggestions
for resolutions of the DRPs. An alert is defined as a general term for a
detected “potential” DRP. The Swedish e-Health Agency’s expert group
is responsible for quality assurance of EES content. Its information is
designed as evidence-based rules, and is constantly updated based on
science and information from government agencies.
EES can detect DRPs including Drug Drug Interactions (based on the Sfinx
database with a classification system of four severity levels), therapy
duplications (dispensing of two or more drugs within the same
therapeutic category), high doses (a prescribed dose exceeding the
maximum daily dose), drug-disease interferences (potential
contraindications for a drug with a disease inferred by prescription
information), drug gender warnings, and inappropriate drugs and doses
for geriatric or pediatric patients.13
To close the alerts generated, the pharmacist must address them by
selecting and specifying one of the seven different categories. The
pharmacist should be able to assess the alerts and evaluate their
clinical relevance before discussing them with a patient or
prescriber.13 Only a few studies have been performed
on EES, then focusing on the doctors’ views on the alerts13 and the most common type of
signals.14 EES is used in about 1300 out of the 1400
pharmacies in Sweden, but only with approximately 20% of the patients
(2018).15
A comparison of DRPs identified by pharmacists with and without EES
support has previously not been studied. This study was conducted as a
BSc in Pharmacy thesis at Malmö University, Sweden.
The aim of this study was to investigate whether the use of the pharmacy
based EES would identify and resolve more actual patient DRPs.