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. 1999 Jun;47(6):695-700.
doi: 10.1046/j.1365-2125.1999.00964.x.

Clinical pharmacy interventions by community pharmacists during the dispensing process

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Clinical pharmacy interventions by community pharmacists during the dispensing process

G M Hawksworth et al. Br J Clin Pharmacol. 1999 Jun.

Abstract

Aims: To evaluate the professional contact between the community pharmacist and general practitioner during the dispensing process on issues other than the legality or simple clarification of the prescription.

Methods: Fourteen community pharmacists from five adjacent localities completed details of each clinical pharmacy intervention during 1 week of each month for a period of 1 year. Each week of the month was randomly selected. When a community pharmacist had to contact the prescriber, during the dispensing of a prescription, the following data were recorded: brief patient details, the prescribed drug therapy, the reason for intervention, the outcome and the time taken. The main outcome measures were the type and nature of each intervention, the BNF category of the drug involved and the time taken. A multidisciplinary clinical panel assessed the potential of each intervention to alter the outcome of the patient's clinical management and to prevent a drug related hospital admission. These assessments were ranked between 0 and 10 (100% confident).

Results: During a period covering 1 week per month over 1 year, 1503 clinical pharmacy interventions were made out of 201 000 items dispensed. When normalized for the dispensing volume of each community pharmacy the lower the number of items dispensed then the greater was the percentage of interventions (P=0.013). The clinical panel decided that between 19 (0.01% of the total items dispensed) and 242 (0.12%) interventions may have prevented a drug-related hospital admission, 71 (0.04%) to 483 (0.24%) could have prevented harm whilst 103 (0.05%) to 364 (0.18%) had the potential to improve the efficacy of the intended therapeutic plan. The panel also decided that 748 (0.37%) interventions improved the clinical outcome and could have saved a visit to or by the general practitioner. Conclusion Clinical pharmacy provided by a community pharmacist during the dispensing process has the potential to provide a valuable contribution to health care.

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Figures

Figure 1
Figure 1
The community pharmacists’ reasons for the clinical pharmacy interventions (a) missing drug; (b) drug not required; (c) discuss information about a drug; (d) change a drug; (e) alter the formulation; (f) dose; (g) dosage interval; (h) recommend monitoring; (i) drug review; (j) others.
Figure 2
Figure 2
The clinical pharmacy interventions according to the BNF category of the drug: 1—g.i; 2—CNS; 3—resp; 4—CNS; 5—infections; 6—endocrine; 7—obs; gynae and U.T.I; 8—malignant dis. and immunosuppression; 9—nutrition and blood; 10—musculoskeletal and joint dis; 11—eye; 12—ear, nose and oropharynx; 13—skin.

References

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    1. The Royal Pharmaceutical Society of Great Britain and Department of Health Joint Working Party. Pharmaceutical Care: the Future for Community Pharmacy. London: The Royal Pharmaceutical Society of Great Britain; 1992.
    1. The Royal Pharmaceutical Society of Great Britain. The New Horizon: Pharmacy in a New Age. London: The Royal Pharmaceutical Society of Great Britain; 1996.
    1. Department of Health. Choice and Opportunity: Primary Care: the Future. London: HMSO October; 1996.
    1. Department of Health. The NHS—a Service with Ambitions. London: HMSO; November 1996.

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