[Physician-pharmacist collaboration: a way to improve the quality of drug prescribing]. / Qualité de la prescription médicamenteuse: des progrès grâce a la collaboration médecins- pharmaciens.

The medical prescription is the end-result of a structured process. It is, in effect, a medicolegal document that binds the physician who writes it as well as the pharmacist who delivers it, with a civil duty of care that is protected by penal sanction. Moreover, prescriptions carry important costs, and can be the source of errors, especially where there are breakdowns in the continuity of patient care. These features underline the importance of the act of "prescribing", and the need for ways to improve its quality through increased efficiency and safety. The Swiss experience of physicians-pharmacists Quality Circles for drug prescription in the community and in the nursing homes, represent with the medication review, one method of safeguarding quality prescribing.

Using the costs of drug therapy to screen patients for a community pharmacy-based medication review program.

OBJECTIVES: To measure the positive predictive value (PPV) of the cost of drug therapy (threshold = 2000 Swiss francs [CHF], US$1440, 1360) as a screening criterion for identifying patients who may benefit from medication review (MR). To describe identified drug-related problems (DRPs) and expense problems (EPs), and to estimate potential savings if all recommendations were accepted. SETTING: Five voluntary Swiss community pharmacies. METHODS: Of 12,680 patients, 592 (4.7%) had drug therapy costs exceeding 2000 CHF over a six-month period from July 1 to December 31, 2002. This threshold limit was set to identify high-risk patients for DRPs and EPs. Three pharmacists consecutively conducted a medication review based on the pharmaceutical charts of 125 sampled patients who met the inclusion criterion. MAIN OUTCOME MEASURE: The PPV of a threshold of 2000 CHF for identifying patients who might benefit from a MR: true positives were patients with at least one DRP, while false positives were patients with no DRP. RESULTS: The selection based on this criterion had a PPV of 86% for detecting patients with at least one DRP and 95% if EPs were also considered. There was a mean of 2.64 (SD = 2.20) DRPs per patient and a mean of 2.14 (SD = 1.39) EPs per patient. Of these patients, 90% were over 65 years old or were treated with at least five chronic medications, two common criteria for identifying patients at risk of DRPs. The main types of DRPs were drug-drug interactions, compliance problems and duplicate drugs. Mean daily drug cost per patient was CHF 14.87 (US$10.70, 10.10). A potential savings of CHF 1.67 (US$1.20, 1.14) per day (11%) was estimated if all recommendations to solve DRPs and EPs suggested herein were implemented. CONCLUSION: Further studies should investigate whether the potential benefit of medication reviews in preventing DRPs and containing costs in this patient group can be confirmed in a real practice environment.

Practical evaluation of the drug-related problem management process in Swiss community pharmacies.

OBJECTIVE: To develop and evaluate a coding system integrated into pharmaceutical software to routinely report and assess the process of community pharmacists' interventions related to medical prescriptions. SETTING: A convenient sample of 20 Swiss community pharmacies. METHOD: Pharmacists documented their interventions concerning all drug-related problems (DRPs) related to medical prescriptions during four consecutive weeks in 2005. The coding system assesses each step of the DRP management process; that is, the type of problem, possible negative outcomes, pharmaceutical decisions, and individuals involved. In order to be comprehensive, the management process of technical problems related to prescriptions and clinical DRPs was analysed separately. MAIN OUTCOME MEASURE: DRP intervention rate and characterization of each step of the process. RESULTS: Of 38,663 prescriptions, 287 clinical DRPs required interventions. This corresponds to a mean intervention rate of 0.77% per pharmacy (SD = 0.61%). There was a large variability among pharmacies (0-2.6%). Most of the clinical DRPs were associated with dosage problems (n = 91) and drug-drug interactions (n = 45). The most frequent potential negative outcomes reported were quantitative inefficacy (n = 101) and quantitative safety (n = 94). Two-thirds of clinical DRPs required a prescription modification (n = 186), the most frequent being a change in dosage or drug regimen. In 110 interventions (38%), physicians were immediately contacted to take part in the decision. In 122 interventions (43%), pharmacists managed the interventions alone. However, in 55 interventions (19%), pharmacists managed the DRPs with the patient. From these 287 clinical interventions, 134 different codes were reported. Seven hundred and thirty-six technical problems related to prescriptions required intervention, which corresponded to a mean intervention rate of 1.90% per pharmacy. The main type of problem was a discrepancy with the medication record (n = 208). There were 494 instances that required a prescription modification. Pharmacists resolved 45% of all technical problems by themselves. CONCLUSION: The developed coding system could describe the management process for DRPs. The observed intervention rate and the frequency of steps involved were comparable to those previously observed for pharmacists' interventions. Data regarding the entire process used to manage drug-related problems can be useful in improving medication safety, education, and collaborative care.