Clinical Trial Summary
Drug Related Problem (DRP) is defined as an event that may potentially affect the health
outcomes in the patients. DRPs can occur at all stages of the medication usage process
starting from prescribing (included medication error and inappropriate prescription) to
dispensing stage. Lack of follow-ups and reassessment of therapeutic outcomes may also
contribute to DRPs. Pharmaceutical care is a co-operative activity in concert with other
health care professionals and offered directly to the patient for improved quality use of
medicines. Pharmaceutical care identifies and resolves actual or potential DRPs.
In our clinical practice, during the patient admission in internal medicine unit, a
medication reconciliation process was conducted according to a validated protocol. The first
step consists of getting the Best Possible Medication History (BPMH), defined as the most
comprehensive list of all medications taken by the patient. The second step consists of
comparing the BPMH with admission prescription made by the physician in charge. During
pharmacist interview, pharmacist discussed about medication adherence and knowledge. The
third step consists of characterizing, solving and documenting DRPs.
During the patient's hospitalization, the pharmacist participates at the medication
prescription revision. At the discharge of hospitalization, a pharmaceutical standardised
interview is carried out during which the pharmacist explains the modifications of treatments
to the patient. During this interview, the hospital pharmacist updates the latest treatment
changes. For patient with more than 65 years old and long-term affection (or patient with
more than 75 years old with or without long-term affection) and 5 medications, the hospital
pharmacist write a medication discharge report (MDR) to patient, community pharmacist and
general practitioner.
For each medication, the investigators collected its name, dosage, dosage forms and frequency
of administration. For each DRP, the investigators collected the type of DRP and the drug
classes (according to anatomical therapeutic chemical classification system).
For each MDR, the investigators collected number of medication, number and type of DRP
including inappropriate prescription.
