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.

Pharmacist-led intervention study to improve inhalation technique in asthma and COPD patients.

UNLABELLED: RATIONAL AND AIMS: Inhaled therapy is the mainstay of treatment in patients with asthma and chronic obstructive pulmonary disease (COPD). For effectiveness of pharmacotherapy, correct use of medication is required. The aims of this study were to survey the quality of inhalation technique in patients and to determine the effect of a single intervention in community pharmacies by means of standardized procedures. METHODS: A total of 757 patients with asthma or COPD were randomly selected by 55 community pharmacies. At baseline, patients were interviewed and their inhalation technique was assessed with a 21-items checklist. Any error was recorded and, if necessary, patients were instructed in the proper use of their device. After 4-6 weeks, demonstration of inhalation technique was repeated in the community pharmacies and a pre-post comparison was performed. RESULTS: A total of 597 patients (78.9%) made at least one mistake in performing the inhalation technique at baseline. This number dropped to 214 (28.3%) from the first to the second appointment. All patients did benefit from the pharmacists' intervention regardless of their former training experiences. CONCLUSIONS: Inhalation technique of asthma and COPD patients is poor. In daily practice, community pharmacy-based pharmacists are well suited to significantly supplement doctor-based education in inhalation technique.

[Involving pharmacists in the management of asthma patients]. / Versorgungsmanagement für Menschen mit Asthma--Einbindung der Apotheker.

Several national and international studies on the care of asthma patients delivered by community pharmacists have shown that pharmacist interventions help to improve patient parameters like, for example, the patient's quality of life, self-management skills, compliance and optimization of drug therapy. These results have led to pharmacists' involvement in national asthma guidelines, e.g., in the UK and the United States. Pharmacists have now also been involved in the revised version of the German national guidelines on asthma. In this paper we will present the existing evidence in Germany on how pharmacists add value to the care of asthma patients. Furthermore, the involvement of pharmacists in the German National Disease Management Guideline for Asthma will be discussed.

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.

German national drug information service: user satisfaction and potential positive patient outcomes.

OBJECTIVE: The pharmacist-run national German drug information service (DIS) has operated since 1988. Answering a steadily increasing demand over the past decade, our centre has, in total, provided information in more than 14,000 cases, mainly for community pharmacists. Information on user's satisfaction and on possible direct or indirect benefits for patients is as yet scarce. Our objectives were to assess user's satisfaction with the DIS and to identify any patient-related benefits based on the user's judgment. SETTING: Independent national drug information centre at ABDA headquarters. METHOD: A questionnaire was developed, pre-tested, optimized, and used in daily practice over a period of one year (09/2003-08/2004). The questionnaire comprised seven items, aimed only at inquiries which pertained to a patient-related issue. RESULTS: During the study period, a total of 1,639 inquiries were answered. Of these, 1,017 (62%) were eligible. The response rate was 45% (455/1,017). Ratings (1 = poor to 5 = very good, mean +/- SD) showed positive evaluations for professional quality of advice (4.7 +/- 0.5), clarity/understandability of advice (4.7 +/- 0.5), timeliness of response (4.6 +/- 0.7), and helpfulness regarding counselling patients and/or physicians (4.6 +/- 0.6). Potential patient benefits could be identified in 42% of the cases that were available to follow-up (190/455). CONCLUSION: This evaluation showed high satisfaction among users of a nationwide DIS, based on quality, understandability, timeliness, and helpfulness regarding counselling. According to its users, DIS was also able to provide positive patient outcomes.

Community pharmacy-based intervention to improve self-monitoring of blood glucose in type 2 diabetic patients

Self-monitoring of blood glucose (SMBG) is clearly correlated with increased life expectancy and quality of life in type 2 diabetic patients. Objective: The objective of our study was to record and assess the errors patients make in preparing, performing, and processing self-monitoring of blood glucose (SMBG). Furthermore, the study aimed to determine to what extent a single standardized SMBG instruction session in a community pharmacy might reduce the number of patients making errors or the number of errors per patient. Methods: Between May and October 2005, SMBG of 462 randomly selected patients with type 2 diabetes was monitored in 32 pharmacies specialized in diabetes care. The patients performed blood glucose self-tests using their own blood glucose meters. Self-testing was monitored using a standardized documentation sheet on which any error made during the performance of the test was recorded. If necessary, patients were instructed in the accurate operation of their meter and the use of the necessary equipment. Additionally, patients obtained written instructions. Six weeks later, assessment of the quality of patient’s SMBG was repeated. Results: During the first observation, 383 patients (83%) made at least one mistake performing SMBG. By the time of the second observation, this frequency had fallen to 189 (41%) (p<0.001). The average number of mistakes fell from 3.1 to 0.8 per patient. Mistakes that may potentially have led to inaccurate readings were initially recorded for 283 (61%) and at study end for 110 (24%) patients (p<0.001). Conclusion: It is important to periodically instruct type 2 diabetic patients in the proper SMBG technique in order to ensure accurate measurements. In this study it was shown that community pharmacies specialized in diabetes care can provide this service effectively (AU)

El auto-control de la glucemia está claramente correlacionado con un aumento de la esperanza de vida y la calidad de vida en diabéticos tipo 2. Objetivo: El objetivo de nuestro estudio fue registrar y evaluar los errores que cometen los pacientes al preparar, ejecutar y procesar el autocontrol de glucemia. Además el estudio trató de determinar como una formación estandarizada de autocontrol de glucemia en una farmacia comunitaria podría reducir el número de pacientes que cometen errores o el número de errores por pacientes. Métodos: Entre mayo y octubre de 2005, se seleccionaron autocontroles de glucemia de 462 pacientes con diabetes tipo 2 aleatoriamente elegidos en 32 farmacias especializadas en atención de diabetes. Los pacientes realizaron autocontroles de glucemia usando su propio medidor. El autocontrol fue monitorizado utilizando una hoja estandarizada de documentación en la que se registraba cada error cometido durante la ejecución. Si era necesario, se instruía a los pacientes en la operativa adecuada de su medidor y en el uso del equipo necesario. Además, se entregaban a los pacientes instrucciones escritas. Seis semanas después, se repetía la evaluación de la calidad del autocontrol de glucemia del paciente. Resultados: Durante la primera observación, 383 pacientes (83%) cometieron al menos un error en la ejecución. En la segunda observación esta frecuencia había caído a 189 (41%) (p<0,001). La media de errores calló de 3,1 a 0,8 por paciente. Los errores que podían potencialmente llevar a lecturas inadecuadas fueron inicialmente en 283 (61%) y el final del estudio en 110 (24%) de los pacientes (p<0,001). Conclusión: Es importante instruir periódicamente a los diabéticos tipo 2 en el uso correcto de la técnica de autocontrol de la glucemia para asegurar mediciones exactas. En este estudio se mostró que las farmacias comunitarias especializadas en atención de diabetes pueden proporcionar este servicio de modo efectivo (AU)

Community pharmacy-based intervention to improve self-monitoring of blood glucose in type 2 diabetic patients.

UNLABELLED: Self-monitoring of blood glucose (SMBG) is clearly correlated with increased life expectancy and quality of life in type 2 diabetic patients. OBJECTIVE: The objective of our study was to record and assess the errors patients make in preparing, performing, and processing self-monitoring of blood glucose (SMBG). Furthermore, the study aimed to determine to what extent a single standardized SMBG instruction session in a community pharmacy might reduce the number of patients making errors or the number of errors per patient. METHODS: Between May and October 2005, SMBG of 462 randomly selected patients with type 2 diabetes was monitored in 32 pharmacies specialized in diabetes care. The patients performed blood glucose self-tests using their own blood glucose meters. Self-testing was monitored using a standardized documentation sheet on which any error made during the performance of the test was recorded. If necessary, patients were instructed in the accurate operation of their meter and the use of the necessary equipment. Additionally, patients obtained written instructions. Six weeks later, assessment of the quality of patient's SMBG was repeated. RESULTS: During the first observation, 383 patients (83%) made at least one mistake performing SMBG. By the time of the second observation, this frequency had fallen to 189 (41%) (p<0.001). The average number of mistakes fell from 3.1 to 0.8 per patient. Mistakes that may potentially have led to inaccurate readings were initially recorded for 283 (61%) and at study end for 110 (24%) patients (p<0.001). CONCLUSION: It is important to periodically instruct type 2 diabetic patients in the proper SMBG technique in order to ensure accurate measurements. In this study it was shown that community pharmacies specialized in diabetes care can provide this service effectively.