Pharmaceutical care: the PCNE definition 2013.

BACKGROUND: Twenty-three years after Hepler and Strand published their well-known definition of Pharmaceutical Care (PhC), confusion remains about what the term includes and how to differentiate it from other terms. The board of the Pharmaceutical Care Network Europe (PCNE) felt the need to redefine PhC and to answer the question: "What is Pharmaceutical Care in 2013". OBJECTIVE: The aims of this paper were to review existing definitions of PhC and to describe the process of developing a redefined definition. METHODS: A literature search was conducted in the MEDLINE database (1964-January 2013). Keywords included "Pharmaceutical Care", "Medication (Therapy) Management", "Medicine Management", and "Pharmacist Care" in the title or abstract together with the term "defin*". To ease comparison between definitions, we developed a standardised syntax to paraphrase the definitions. During a dedicated meeting, a moderated discussion about the definition of PhC was organised. RESULTS: The initial literature search produced 186 hits, with eight unique PhC definitions. Hand searching identified a further 11 unique definitions. These 19 definitions were paraphrased using the standardised syntax (provider, recipient, subject, outcome, activities). Fourteen members of PCNE and 10 additional experts attended the moderated discussion. Working groups of increasing size developed intermediate definitions, which had similarities and differences to those retrieved in the literature search. At the end of the session, participants reached a consensus on a "PCNE definition of Pharmaceutical Care" reading: "Pharmaceutical Care is the pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes". CONCLUSIONS: It was possible to paraphrase definitions of PhC using a standardised syntax focusing on the provider, recipient, subject, outcomes, and activities included in PhC practice. During a one-day workshop, experts in PhC research agreed on a definition, intended to be applicable for the present time, representative for various work settings, and valid for countries inside and outside of Europe.

Drug-related problems in prescribed medicines in Germany at the time of dispensing.

BACKGROUND: Drug-related problems (DRPs) can have an important impact on the effectiveness and safety of pharmacotherapy. In Germany, the frequency of DRPs in prescribed medicines in ambulatory care is not yet known. Objective To quantify DRPs in prescribed medicines identified by community pharmacists (CPs) at the time the medicine is dispensed. SETTING: German CPs in four different regions. METHOD: We invited CPs to document one hundred consecutive patients presenting prescriptions using a standardized documentation form. For each patient, person- and medication-related as well as identified DRP-related data were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed. MAIN OUTCOME MEASURE: Nature and frequency of DRPs. RESULTS: In total, 143 CPs documented 14,231 patients with 24,422 prescribed drugs and identified DRPs in 2,556 patients (18.0%). Analyses resulted in 0.23 DRPs per patient and 0.13 DRPs per prescribed medicine. Four DRPs were responsible for almost 70% of all DRPs: Potential drug-drug interaction (22.9%), dose not known to patient (21.7%), patient insecure due to generic substitution (13.5%), and insufficient patient knowledge of correct drug use (10.9%). If a patient's drug file was kept in the pharmacy, specific types of DRPs were detected more frequently e.g., drug-drug interactions (p < 0.001). Interventions primarily comprised counselling, monitoring, and changing drug or instructions for use. The prescribing physician was contacted in 28% of DRPs resulting in a change of these prescriptions in 50% of the cases. Overall and according to the pharmacists, more than 90% of the DRPs detected were partially (10.4%) or completely (85.4%) solved. CONCLUSION: We quantified DRPs in prescribed medicines in daily ambulatory care practice in Germany. When filling a prescription, in nearly 20% of the patients relevant DRPs were revealed. According to the pharmacists, the majority could be partially or completely solved during the encounter at the pharmacy. Keeping a patient's drug file including patient specific data may facilitate the detection of DRPs and shall, therefore, be offered to patients more often.

Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany.

PURPOSE: To quantify drug-related problems (DRPs) in self-medication (over-the-counter [OTC] drug use) identified by community pharmacists (CPs) in Germany at the time the drug is dispensed. METHODS: One hundred CPs were asked to document 100 consecutive customers presenting symptoms or requesting OTC drugs using a standardized documentation form. The number of 10,000 encounters seemed reasonable to evaluate the set objective. For each encounter, data such as age, sex, and first or repeated request and the availability of a patient file in the pharmacy including drug history were documented. Furthermore, identified DRPs, problem descriptions, and solutions were documented. Data were transcribed electronically, coded, checked for validity, and analyzed. RESULTS: In total, 109 CPs documented 12,567 encounters identifying DRPs in 17.6% of all cases. Four indications comprised more than 70% of all DRPs: pain, respiratory, gastrointestinal, and skin disorders. Four DRPs were responsible for almost 75% of all DRPs identified: self-medication inappropriate (29.7%), requested product inappropriate (20.5%), intended duration of drug use too high including abuse (17.1%), and wrong dosage (6.8%). If a drug history was available, significantly more cases with wrong dosage (p < 0.05) and drug-drug interactions (p < 0.001) were detected. All patients with identified DRPs were counseled accordingly. Furthermore, the most frequent interventions were referral to a physician (39.5%) and switching to a more appropriate drug (28.1%). CONCLUSIONS: In nearly one of five encounters, a direct pharmacist-patient interaction about self-medication revealed relevant DRPs. Having access to patient files including data on prescription and OTC drugs may increase patient safety.

Survey of drug-related problems identified by community pharmacies.

BACKGROUND: A drug-related problem (DRP) is defined as an event or circumstance that actually or potentially interferes with desired health outcomes. DRPs can lead to ineffective pharmacotherapy and may cause drug-related morbidity and mortality. Most DRPs are avoidable and community pharmacies are assuming an active role in preventing and solving DRPs. OBJECTIVE: To identify the spectrum of DRPs encountered in community pharmacies. METHODS: In 2005, a nationwide survey in Germany was conducted in community pharmacies to record all identified DRPs. Participating community pharmacies were free to select one week within the designated study period (February-May) and were instructed to record basic statistics (eg, number of patient interactions, number of prescriptions filled/nonprescription [over-the-counter; OTC] drugs dispensed per week), as well as patient-, problem-, and intervention-related data (eg, patient age and sex, whether a prescription-only or OTC drug was involved in the DRP, the time needed for problem resolution). DRPs were categorized using a modified version of the PI-Doc (problem-intervention-documentation) classification system. RESULTS: Community pharmacies that participated in the study (N = 1146) documented 10,427 DRPs (9.1 DRP per pharmacy per week). A broad spectrum of DRPs was identified, with 9 of 10 cases involving prescribed medicines. DRPs arose on 3 primary levels: the prescription-, the patient-, and the delivery level. Overall, drug-drug interactions were the most frequently reported DRP (8.6%) and, according to community pharmacies, more than 80% of identified DRPs could be resolved completely. The prescribing physician was contacted in 60.5% of all such cases. Median time needed for solving a DRP was 5 minutes. CONCLUSIONS: Pharmacists in the community pharmacy setting are well suited to identify and resolve DRPs. Ensuring the proper use of both prescription and OTC drugs is one of the basic responsibilities of pharmacists. This specific role of pharmacists within the healthcare system needs to be more fully recognized.

Pharmacy interns on the ward--a pilot study.

OBJECTIVE: To assess the feasibility and impact of the activities of pharmacy interns on German hospital wards as well as the acceptance of their activities by medical and pharmaceutical staff. METHOD: The project was carried out for 36 months in six hospitals on different wards. Seventeen interns spent three months first in the pharmacy followed by another three months in the wards. Information about their tasks on different wards was obtained through reporting by interns on a standardized data collection form. Questionnaires regarding acceptance and impact of pharmacy interns were answered by medical and pharmaceutical staff. RESULTS: After having adjusted to their tasks, the interns investigated and developed solutions for structural and process-related slacks in the handling of medicines in the wards. They focused on drug information, on the detection and prevention of medication and documentation errors and storage of medicines in the wards. One hundred and forty six questionnaires regarding acceptance, impact and possible tasks of the interns were answered. Ninety percent of the surveyed medical staff considered the work of the interns as useful and 89% were in favour of permanent interns in the wards. The acceptance by pharmaceutical staff was slightly lower. CONCLUSION: This pilot study represents a landmark for the implementation of clinical pharmacy in daily practice especially on medical wards in Germany. Working in wards offers interns a possibility to extend their knowledge and skills. The project demonstrates that pharmacy interns can play an important role in drug safety in hospital wards. The acceptance by physicians and nurses is high. The majority of them requested the continuation of the project.

Determination of free and liposome-associated daunorubicin and daunorubicinol in plasma by capillary electrophoresis.

Liposomal daunorubicin (DaunoXome) is a formulation of the anticancer drug daunorubicin encapsulated into vesicles of about 45 nm diameter. To understand the pharmacodynamic relationships associated with the toxicity and efficacy of liposome-encapsulated daunorubicin in vivo and in vitro, it is essential to have a rapid method of separating the free and liposomal forms of the drug. We have developed and validated a method to quantify drug concentrations of liposomal daunorubicin, free daunorubicin and its main metabolite daunorubicinol that requires only 50 microl of plasma to conduct studies in children. The method involves the use of solid-phase extraction followed by capillary electrophoresis with laser-induced fluorescence (LIF) detection. With LIF detection a limit of quantification of 1 microg/l is obtained for the free form and the metabolite. Precision and accuracy are in accordance with the generally accepted criteria for bioanalytical methods. The method is rapid and allows for multiple samples to be processed simultaneously.