Prevalence of potentially inappropriate medications among newly treated patients with type 2 diabetes in UK primary care.

AIMS: The aim of this study was to estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first noninsulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. METHODS: A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society Beers criteria 2015 was used for older (≥65 years) patients and the Prescribing Optimally in Middle-age People's Treatments criteria was used for middle-aged (45-64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymized electronic health records in the UK. RESULTS: Among 28 604 patients initiating NIADs, 18 494 (64.7%) received polypharmacy. In older and middle-aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIP. At the individual PIP level, long-term proton pump inhibitors (PPI) use was the most frequent PIP among older adults, and strong opioid without laxatives was the most frequent PIP in middle-aged patients with polypharmacy (11.1% and 4.1%, respectively). CONCLUSIONS: This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimization.

Hepatitis C virus screening in community pharmacies: results on feasibility from a Swiss pilot.

BACKGROUND: Hepatitis C virus (HCV) infections are a public health burden worldwide and often go undetected until sequelae develop. Offering HCV screening for the different vulnerable populations in community pharmacies could help prevent further undetected HCV infections. This pilot aimed to assess the feasibility and pharmacist acceptance of HCV rapid antibody saliva testing in community pharmacies. METHODS: A structured pharmaceutical care intervention was developed that included addressing, informing, and screening clients, as well as referral and reporting to subsequent health care providers. Participating pharmacies from French-, German- and Italian-speaking parts of Switzerland were trained to provide this service to local vulnerable populations. Information on client recruitment, feasibility, and acceptability of HCV screening was collected. RESULTS: Of 36 pharmacies initially recruited, 25 started the pilot and approached 435 clients, 145 of whom (33%) were interested in screening. Eight of these rapid antibody tests returned positive (prevalence rate: 5.5%). Facilitators were being able to offer a free rapid test (73%), followed by having training prior to the project (67%) and having a new service to offer (67%). The possibility of clients reacting dismissively (53%) and of unsettling clients (47%) were reported to be the main barriers. CONCLUSIONS: This pilot demonstrated the general feasibility of an HCV screening service with rapid antibody saliva testing in Swiss community pharmacies, which achieved a higher prevalence rate than national estimates. With appropriate communication training and remuneration, Swiss community pharmacies could be an important partner in implementing HCV elimination strategies.

An explorative analysis of pharmacovigilance data of oxytocin and its analogue carbetocin, with a focus on haemodynamic adverse effects.

BACKGROUND: Oxytocin and its analogue carbetocin are uterotonics whose prophylactic use is recommended to prevent postpartum haemorrhage, which is one of the leading causes of maternal deaths worldwide. However, both drugs can cause specific adverse effects and haemodynamic challenges. AIM: The aim of this work was to exploratively examine reports of adverse drug events of both drugs and to establish a comparative haemodynamic profile. METHOD: Using data extracted from the World Health Organization's pharmacovigilance database VigiBase, a descriptive analysis was performed of all reports for oxytocin and carbetocin as a suspected or interacting drug followed by a disproportionality analysis for haemodynamic events. Reporting odds ratios (ROR) of carbetocin for hypertension, hypotension, tachycardia, and bradycardia were calculated, with oxytocin-related reports serving as comparators. RESULTS: Oxytocin and carbetocin were mentioned as suspected or interacting drugs in 11,258 and 374 reports, respectively. Resulting RORs for carbetocin were 3.45 (95%CI: 1.72-6.92) for hypertension, 2.65 (1.64-4.28) for hypotension, 2.84 (1.79-4.49) for tachycardia, and 2.00 (0.87-4.60) for bradycardia, when compared to oxytocin. Of 231 patients for whom oxytocin-related tachycardia was reported, 2.6% died, and of 91 patients for whom bradycardia was reported, 2.2% died. No deaths were reported with carbetocin for any of the haemodynamic adverse events. CONCLUSION: Compared to oxytocin, carbetocin showed an elevated reporting for adverse hypertension, hypotension, and tachycardia in pharmacovigilance data. Clinicians should be aware of their patients' individual susceptibility and the possibility of haemodynamic deterioration until causal inferences are possible.

[Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players]. / Lehrveranstaltung zu interprofessionellen Versorgungsketten in der Schweiz.

Teaching Interprofessional Patient Pathways in Medical Education in Switzerland - A Collaboration of Multiple Players Abstract. The increase of chronic and complex medical disorders challenges actors in the health care system and affects the entire health care system in Switzerland. Through an interprofessional exchange between medical and health care professionals, the individual needs of patients can be better addressed, which has a positive impact on patients' treatments. To prepare students of the Bachelor of Medicine at ETH Zurich for these challenges, the ETH has designed a specific course together with four educational institutions, which is oriented towards the interprofessional, patient-centred supply chain. The aim of this interprofessional module is, that Bachelor of Medicine students, as well as Pharmacy and Nursing students, acquire knowledge about the other areas of responsibility and competences, and at the same time get to know the interfaces of interprofessional cooperations.

Assessment of minor health disorders with decision tree-based triage in community pharmacies.

BACKGROUND: Triaging in community pharmacies can lower the burden of minor health disorders on other primary health care settings. The netCare service, introduced in 2012 by the Swiss association of pharmacists, provides community pharmacists with 27 decision trees for the triage of minor health disorders. OBJECTIVES: (1) to describe the utilization and symptom resolving rate of decision trees in community pharmacies; (2) to identify the need for additional decision trees. METHODS: A descriptive, explorative analysis was conducted of netCare consultations between January 2019 and March 2020, as documented in phS-net, a service platform for public pharmacies. Client characteristics, weekdays, recommended course of action, availability of a general practitioner, and hypothetical course of action if netCare would not have been available were investigated. Follow-up information was assessed for resolution of symptoms and prevention of needing additional services. Data from consultations with empty assessment forms were used to identify minor health disorders in need of an additional decision tree. RESULTS: Information on 4256 performed netCare consultations were identified over a 14-month observation period, resulting in an average of 284 decision tree consultations per month in Switzerland. Customers were mainly female (n = 3253, 76.4%) with a mean age of 40.7 years (±18.5 years). Cystitis (39.5%), conjunctivitis (19.5%), and pharyngitis (10.9%) were the primary reasons for consultation. Minor health disorders were managed by pharmacists themselves (88.2%) and achieved a resolution rate of 84.7%. Eyelid inflammations were identified as in need for an additional decision tree. CONCLUSION: Pharmacist-led structured triaging services in Switzerland led to an 84.7% resolution rate of minor health disorders, thereby identifying the potential for pharmacists to minimize the demand on other primary health care providers.

Community Pharmacist-Administered COVID-19 Vaccinations: A Pilot Customer Survey on Satisfaction and Motivation to Get Vaccinated.

In response to the coronavirus disease 2019 (COVID-19) pandemic, Swiss health authorities approved and ordered two mRNA vaccines in 2021. The canton of Zurich was the second in Switzerland to allow community pharmacists to administer the COVID-19 mRNA Vaccine Moderna to the adult population. We aimed to pilot a customer satisfaction questionnaire regarding COVID-19 vaccinations in Zurich pharmacies. Questions focused on satisfaction with different aspects of the service, motivation for getting the vaccination, and reasons for being vaccinated in a pharmacy. Zurich pharmacies administered 68,169 COVID-19 doses until June 2021, and 421 questionnaires were filled. Respondents' mean age was 43.5 (±13.2) years, with 42.3% reporting being women and 46.1% being men. Of the 372 complete questionnaires, 98.7% of the respondents would have recommended the service to others. High levels of satisfaction were reported concerning pre-vaccination discussion (98.9%), pharmacies' information level on COVID-19 vaccines (98.9%), general comfort with receiving the vaccination in a pharmacy (99.5%), injection technique (99.2%), and premises used (98.1%). Most respondents (57.3%) would have had the option of another vaccination provider, but the pharmacies were chosen for their opening hours, ease of access, and perceived trust. The availability of pharmacist-administered services may be an important contributor to a successful vaccination programme in Switzerland.

External validation of the PAR-Risk Score to assess potentially avoidable hospital readmission risk in internal medicine patients.

BACKGROUND: Readmission prediction models have been developed and validated for targeted in-hospital preventive interventions. We aimed to externally validate the Potentially Avoidable Readmission-Risk Score (PAR-Risk Score), a 12-items prediction model for internal medicine patients with a convenient scoring system, for our local patient cohort. METHODS: A cohort study using electronic health record data from the internal medicine ward of a Swiss tertiary teaching hospital was conducted. The individual PAR-Risk Score values were calculated for each patient. Univariable logistic regression was used to predict potentially avoidable readmissions (PARs), as identified by the SQLape algorithm. For additional analyses, patients were stratified into low, medium, and high risk according to tertiles based on the PAR-Risk Score. Statistical associations between predictor variables and PAR as outcome were assessed using both univariable and multivariable logistic regression. RESULTS: The final dataset consisted of 5,985 patients. Of these, 340 patients (5.7%) experienced a PAR. The overall PAR-Risk Score showed rather poor discriminatory power (C statistic 0.605, 95%-CI 0.575-0.635). When using stratified groups (low, medium, high), patients in the high-risk group were at statistically significant higher odds (OR 2.63, 95%-CI 1.33-5.18) of being readmitted within 30 days compared to low risk patients. Multivariable logistic regression identified previous admission within six months, anaemia, heart failure, and opioids to be significantly associated with PAR in this patient cohort. CONCLUSION: This external validation showed a limited overall performance of the PAR-Risk Score, although higher scores were associated with an increased risk for PAR and patients in the high-risk group were at significantly higher odds of being readmitted within 30 days. This study highlights the importance of externally validating prediction models.

Renal ischemic adverse drug events related to tranexamic acid in women of child-bearing age: an analysis of pharmacovigilance data.

PURPOSE: In response to a large trial, the World Health Organization broadened their recommendation on tranexamic acid to be used for post-partum hemorrhage. A 2013 French periodic safety update report warned of an abnormally high rate of renal cortical necrosis associated with tranexamic acid and other drugs for severe post-partum hemorrhage. We aimed to identify the reporting incidence of adverse thrombo-embolic events among women in child-bearing age who received tranexamic acid, with a focus on renal vascular and ischemic conditions. METHODS: We analyzed individual case safety reports (ICSRs) on renal vascular and ischemic conditions, pulmonary thrombotic and embolic conditions, and peripheral embolism and thrombosis from the database of the World Health Organization - Uppsala Monitoring Centre (WHO-UMC). ICSRs were restricted to reports including tranexamic acid as a suspected drug, sex reported as female, and reported age between 18 and 44 years. Reporting odds ratios (RORs) and 95% confidence intervals (95% CIs) were calculated by comparing ICSRs on tranexamic acid to all other drugs in VigiBase. RESULTS: Within 2245 included ICSRs on tranexamic acid, we identified 29 reports of adverse renal vascular and ischemic conditions, 42 reports of pulmonary thrombotic and embolic conditions, and 41 reports of peripheral embolism and thrombosis. RORs were statistically significant by 32.6-fold (32.62, 95% CI: 22.50-47.29), 2.5-fold (2.52, 95% CI: 1.85-3.42), and 2.7-fold (2.67, 95% CI: 1.96-3.64), respectively, when compared to any other drug within VigiBase. CONCLUSION: Tranexamic acid might bear an increased risk for renal ischemic adverse drug events in women of child-bearing age.

Movement disorders and use of risperidone and methylphenidate: a review of case reports and an analysis of the WHO database in pharmacovigilance.

For patients with attention deficit hyperactivity disorder and comorbid conduct-dissocial disorder, a combination therapy of the psychostimulant methylphenidate and the antipsychotic risperidone may be prescribed. Case reports describe the occurrence of movement disorders under this combination therapy, but clinical trials had limited power to detect these events. This study aimed (1) to summarise published case reports and (2) to analyse pharmacovigilance data consisting of adverse drug event reports to elucidate these reactions. PubMed, Embase, and APA PsycInfo were used to retrieve case reports. For the pharmacovigilance data, aggregated information on individual case safety reports (ICSRs) within the database of suspected adverse drug events by the WHO were analysed. ICSRs were assessed for disproportionality in reporting. Thirteen published case reports (62% male) on movement disorders were identified, with ages between 5 and 15 years. Seven reports (54%) described incidents when risperidone was tapered down or switched to methylphenidate. From the WHO, we identified 25,556 ICSRs (16,118 for methylphenidate, 8,614 for risperidone, and 824 for both). Of these, 953 (5.9%), 1356 (15.7%), and 159 (19.3%) ICSRs reported movement disorders in association with methylphenidate, risperidone or both, respectively. The analyses on disproportionality showed an increased number of ICSRs with movement disorders when the two drugs were coded in combination. The potential of movement disorders as adverse effects might be amplified when methylphenidate and risperidone are used in combination. The results from the literature underline the necessity of caution and patient monitoring when risperidone dosing is modified during methylphenidate therapy.

Community pharmacist-administered seasonal influenza vaccination: a national customer survey.

BACKGROUND: In Switzerland, the influenza vaccination is recommended for high-risk groups and people who have contact with high-risk groups. Since 2015, Swiss pharmacists are allowed to vaccinate healthy adults after acquiring a certificate of competence for vaccination and blood sampling techniques. We aimed to assess customers of the seasonal influenza vaccination in pharmacies in regard to their satisfaction, motivation, and reasons. METHODS: Swiss pharmacies collected survey data during a period of 12 weeks from mid-October 2019 to mid-January 2020. Each participating pharmacy was sent 20 questionnaires to be handed out to vaccinated customers. The questionnaire was available in German and French and subdivided into four sections: demographic information, satisfaction, reasons for getting the vaccination, and reasons for choosing a pharmacy as a place of vaccination. We tested for statistical differences in answer tendencies across strata on questionnaire language, age groups, and levels of education. RESULTS: Of the 1600 surveys sent, 80 pharmacies sent back 656 completed questionnaires (return rate, 41%). Main age bracket was 65-74 years (26.2%), followed by 55-64 years (24.7%), with an equal distribution of reported sex (female, 49.5%). Of the respondents, 99% would have recommended the service and 88.5% felt very comfortable being vaccinated by a pharmacist. Satisfaction included injection technique, used facilities, preparatory discussions, and pricing of the service. Easy scheduling was a main motivation for choosing a pharmacy as the vaccination provider. We identified minor differences in answer tendencies across questionnaire language and age groups, but not across levels of education. CONCLUSION: Customer satisfaction with community pharmacist-administered seasonal influenza vaccinations is high in Switzerland.

Medication Discrepancies in Community Pharmacies in Switzerland: Identification, Classification, and Their Potential Clinical and Economic Impact.

Background: Transitions of care are high-risk situations for the manifestation of medication discrepancies and, therefore, present threats for potential patient harm. Medication discrepancies can occur at any transition within the healthcare system. Methods: Fifth-year pharmacy students assessed a best possible medication list (BPML) during a medication review (based on medication history and patient interview) in community pharmacies. They documented all discrepancies between the BPML and the latest medication prescription. Discrepancies were classified using the medication discrepancy taxonomy (MedTax) classification system and were assessed for their potential clinical and economic impact. Results: Overall, 116 patients with a mean age and medication prescription of 74 (± 10.3) years and 10.2 (± 4.2), respectively, were analyzed. Of the 317 discrepancies identified, the most frequent type was related to strength and/or frequency and/or number of units of dosage form and/or the total daily dose. Although, the majority of discrepancies were rated as inconsequential (55.2%) on health conditions, the remainder posed a potential moderate (43.2%) or severe impact (1.6%). In 49.5% of the discrepancies, the current patients' medication cost less than the prescribed. Conclusion: Community pharmacies are at a favorable place to identify discrepancies and to counsel patients. To improve patient care, they should systematically perform medication reconciliation whenever prescriptions are renewed or added.

Evaluation of drug-related problems and subsequent clinical pharmacists' interventions at a Swiss university hospital.

WHAT IS KNOWN AND OBJECTIVE: The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug-related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. METHOD: We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEOde ). RESULTS AND DISCUSSION: Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost-neutral. WHAT IS NEW AND CONCLUSION: This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards.

Translation and validation of a tool to assess the impact of clinical pharmacists' interventions.

Background The tool CLEO in French language is designed for estimating the potential relevance of pharmacists' interventions (PIs) in three independent dimensions with regard to process-related, clinical, economic, and humanistic impact. Objective We aimed to translate CLEO into German (CLEOde), to demonstrate its feasibility in daily practice, and to validate the German version. Setting Convenience sample of three Swiss hospitals with established clinical pharmacy services. Method We translated CLEO according to the ISPOR Principles of Good Practice. The potential relevance of PIs performed within a 13-day period of routine clinical pharmacy services was then estimated with CLEOde. Ten clinical pharmacists experienced with CLEOde subsequently completed a 19-item questionnaire to assess user's agreement on appropriateness, acceptability, feasibility, and precision of the tool. Additionally, each pharmacist evaluated 10 model cases with CLEOde. Main outcome measure User satisfaction; interrater reliability and test-retest reliability. Results CLEOde was used to estimate the potential relevance of 324 PIs. The reported time needed to complete a single estimation was less than 1 min. The use of CLEOde was seen as appropriate, acceptable, feasible, and precise. Interrater reliability was good for the clinical and economic dimensions and was poor for the organisational dimension; test-retest correlation was strong for all three dimensions with excellent to fair reliability. Conclusion We present CLEOde as a validated tool in German language suitable to estimate the potential relevance of PIs. After further refinement of the organisational dimension, CLEOde could provide a qualitative value to quantitative information on PIs.

Assessing the ability of the Drug-Associated Risk Tool (DART) questionnaire to stratify hospitalised older patients according to their risk of drug-related problems: a cross-sectional validation study.

OBJECTIVES: The Drug-Associated Risk Tool (DART) has been developed as a self-administered questionnaire for patients with the aim of stratifying patients according to their risk of drug-related problems (DRPs). We aimed to validate the ability of the questionnaire to distinguish between hospitalised patients showing lower and higher numbers of DRPs. DESIGN: Cross-sectional study assessing the questionnaire's concurrent criterion validity. SETTING: Five geriatric and the associated physical and neurological rehabilitation wards of a Swiss regional secondary care hospital with 617 beds. PARTICIPANTS: We recruited 110 patients from a total of 437 admissions. Exclusion criteria were insufficient knowledge in spoken or written German, medical conditions preventing meaningful conversations and already receiving pharmacy services. INTERVENTIONS: Comprehensive pharmacist-led clinical medication reviews were performed, including patient interviews, to identify potential and manifest DRPs. A cluster analysis was conducted to assess the discriminatory potential of the DART to group patients according to number (low and high) of identified DRPs. A subsequent discriminatory function analysis was performed to reduce the number of items. We determined which DART items may be used to trigger what type of medication review. RESULTS: Recruited patients had a median age of 79 years and were prescribed a median of 11 drugs. Patients with a median DART score of 10 and a median of 3 DRPs represented one cluster, whereas patients with a median DART score of 15 and a median of 8 DRPs represented another cluster. Discriminatory function analysis reduced the questionnaire to five items with a moderate to strong correlation with the number of DRPs per patient (Spearman's rank correlation ρ=0.44). Additional items were associated with patients benefiting from interviews. CONCLUSIONS: As a self-administered questionnaire for patients, the DART may be used to stratify hospitalised non-acute older patients in groups of having low and high likelihood of DRPs. The analyses showed that a short form of the DART can be used instead of the full tool to identify older inpatients at risk for DRPs. Additional eight items from the DART may be used to initiate additional clinical pharmacy services. The linkage between certain DART questions and type of medication review enables pharmacist resource allocation.

Contribution of Patient Interviews as Part of a Comprehensive Approach to the Identification of Drug-Related Problems on Geriatric Wards.

BACKGROUND: Inappropriate prescribing is linked to increased risks for adverse drug reactions and hospitalisation. Combining explicit and implicit criteria of inappropriate prescribing with the information obtained in patient interviews seems beneficial with regard to the identification of drug-related problems (DRPs) in hospitalised patients. OBJECTIVE: We aimed to investigate the inclusion of pharmacist interviews as part of medication reviews (including the use of explicit and implicit criteria of inappropriate prescribing) to identify DRPs in older inpatients. METHODS: Clinical medication reviews were performed on geriatric and associated physical and neurological rehabilitation wards in a regional secondary care hospital. Data from electronic medical records, laboratory data, and current treatment regimens were complemented with a novel structured patient interview performed by a clinical pharmacist. The structured interview questioned patients on administration issues, prescribed medication, self-medication, and allergies. The reviews included the use of current treatment guidelines, the Medication Appropriateness Index, the Screening Tool of Older People's Prescriptions (STOPP, v2), and the Screening Tool to Alert to Right Treatment (START, v2). The potential relevance of the DRPs was estimated using the German version of the CLEO tool. RESULTS: In 110 patients, 595 DRPs were identified, averaging 5.4 per patient (range 0-17). The structured interviews identified 249 DRPs (41.8%), of which 227 were not identified by any other source of information. The majority of DRPs (213/249, i.e. 85.5%) identified by patient interview were estimated to be of minor clinical relevance (i.e. limited adherence, knowledge, quality of life, or satisfaction). CONCLUSION: We demonstrated that structured patient interviews identified additional DRPs that other sources did not identify. Embedded within a comprehensive approach, the structured patient interviews were needed as data resource for over one-third of all DRPs.

Drug-Associated Risk Tool: development and validation of a self-assessment questionnaire to screen for hospitalised patients at risk for drug-related problems.

INTRODUCTION: Identifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge. OBJECTIVE: To develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients' answers. DESIGN: Prospective validation study. SETTING: Two mid-sized hospitals (300-400 beds). PARTICIPANTS: 195 patients, exclusion criteria: under 18 years old, patients with a health status not allowing a meaningful communication (eg, delirium, acute psychosis, advanced dementia, aphasia, clouded consciousness state), palliative or terminally ill patients. METHODS: Twenty-seven risk factors for the development of DRPs, identified in a previous study, provided the basis of the self-assessment questionnaire, the Drug-Associated Risk Tool (DART). Consenting patients filled in DART, and we compared their answers with objective patient data from medical records and laboratory data. RESULTS: One hundred and sixty-four patients filled in DART V.1.0 in an average time of 7 min. After a first validation, we identified statements with a low sensitivity and revised the wording of the questions related to heart insufficiency, renal impairment or liver impairment. The revised DART (V.2.0) was validated in 31 patients presenting heart insufficiency, renal impairment or liver impairment as comorbidity and reached an average specificity of 88% (range 27-100) and an average sensitivity of 67% (range 21-100). CONCLUSIONS: DART showed a satisfying feasibility and reliability. The specificity of the statements was mostly high. The sensitivity varied and was higher in statements concerning diseases that require regular disease control and attention to self-care and drug management. Asking patients about their conditions, medications and related problems can facilitate getting a first, broad picture of the risk for DRPs and possible pharmaceutical needs.

Determination of risk factors for drug-related problems: a multidisciplinary triangulation process.

INTRODUCTION AND OBJECTIVES: Drug-related problems (DRPs) constitute a frequent safety issue among hospitalised patients leading to patient harm and increased healthcare costs. Because many DRPs are preventable, the specific risk factors that facilitate their occurrence are of considerable interest. The objective of our study was to assess risk factors for the occurrence of DRPs with the intention to identify patients at risk for DRPs to guide and target preventive measures where they are needed most in patients. DESIGN: Triangulation process using a mixed methods approach. METHODS: We conducted an expert panel, using the nominal group technique (NGT) and a qualitative analysis, to gather risk factors for DRPs. The expert panel consisted of two consultant hospital physicians (internal medicine and geriatrics), one emergency physician, one independent general practitioner, one clinical pharmacologist, one clinical pharmacist, one registered nurse, one home care nurse and two independent community pharmacists. The literature was searched for additional risk factors. Gathered factors from the literature search and the NGT were assembled and validated in a two-round Delphi questionnaire. RESULTS: The NGT resulted in the identification of 33 items with 13 additional risk factors from the qualitative analysis of the discussion. The literature search delivered another 39 risk factors. The 85 risk factors were refined to produce 42 statements for the Delphi online questionnaire. Of these, 27 risk factors were judged to be 'important' or 'rather important'. CONCLUSIONS: The gathered risk factors may help to characterise and identify patients at risk for DRPs and may enable clinical pharmacists to guide and target preventive measures in order to limit the occurrence of DRPs. As a further step, these risk factors will serve as the basis for a screening tool to identify patients at risk for DRPs.