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.