A classification system for issues identified in pharmaceutical care practice

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Abstract
Objective: To investigate the usefulness of a system for classifying pharmaceutical care issues (PCIs), defined in Scottish practice guidelines as “an element of a pharmaceutical need which is addressed by the pharmacist,” which were identified during the delivery of pharmaceutical care in a primary care setting. Method: The classification system had 12 categories, each with a definition and examples reflecting the primary care setting to assist in assigning categories to individual PCIs. There was no category of “other” or “miscellaneous”. The system was used by two clinical pharmacists in a study involving 332 patients aged 65 years or over collecting four or more medicines regularly. The point at which PCIs were identified and resolved, the drugs involved and the actions required to resolve them were analysed for each type of PCI. Setting: Six randomly selected medical practices in the Grampian region of Scotland. Key findings: All 2,586 PCIs identified were successfully assigned one category within this classification system. The most commonly occurring types of PCI were “potential adverse drug reaction”, “need for monitoring”, “potentially ineffective therapy” and “need for education.” Most PCIs classed as “potential adverse drug reaction” and “need for monitoring” were identified from the prescription record. A third of “potentially ineffective therapy” PCIs, plus most PCIs classed as “drug use — no indication” and “indication — no treatment” were identified from medical records. Patient interview identified most of the PCIs categorised as “need for education,” “suspected adverse drug reaction” and “actual compliance issue.” Resolving the “need for education,” “suspected/actual compliance issue” and “out of date medicines” PCIs mostly involved the patient, whereas those involving changes to prescribed therapy or monitoring required contact with a health care professional. Conclusion: The classification system was comprehensive in its coverage of PCIs arising from clinical pharmacists' direct patient care activities in a primary care setting. While the system requires further development and testing, it would appear to be a useful tool for researchers and practitioners to use in describing and comparing PCIs in different studies and using different practices.