Relevance of therapeutic prescription modifications in Dutch community pharmacies.

Abstract

Objectives: Community pharmacists modify prescriptions to solve or prevent drug-related problems. To assess the relevance of prescription modifications, they are usually judged on clinical outcomes only, overlooking their humanistic and economic impact. This study aims to evaluate therapeutic prescription modifications performed by Dutch community pharmacists in terms of clinical outcome, along with the humanistic aspect "usability" and economic aspect "efficiency."

Methods: A multidisciplinary panel evaluated the relevance of 160 cases of therapeutic prescription modifications collected in community pharmacies. Cases were stratified for type of drug-related problem based on their frequency in the original set of modifications. Both the relevance in general and the impact on the individual aspects of effectiveness and medication safety, usability, and efficiency were evaluated.

Key findings: Sixteen cases (10.0%) were excluded because of insufficient information for evaluation. Sixty percent of the 144 cases were evaluated as relevant (56.3% relevant and 4.2% highly relevant). The remaining cases (31.9%) were moderately relevant. For 7.6% of the cases, evaluations were inconclusive. In 25.0% of the cases, there was a major improvement on at least one of the aspects effectiveness, medication safety, usability, or efficiency.

Conclusions: The majority of therapeutic prescription modifications performed by Dutch community pharmacists were evaluated as relevant or highly relevant by a multidisciplinary panel. Modifications improved clinical, humanistic, and economic aspects. This shows the important role of community pharmacists in primary healthcare. Sharing more clinical information like indication, illness severity, and treatment plan will enable pharmacists to improve their contribution to safe medication use.