Medicatiebeoordeling in de openbare apotheek: Prevalentie van geneesmiddelgerelateerde problemen bij ouderen met polyfarmacie en inzicht in patiënt-, behandelings- en ziektegerelateerde factoren

OBJECTIVE: To evaluate the process of clinical medication review (CMR) in a large number of community pharmacies. The effects of patient-, disease- and treatment-related factors on the occurrence of drug-related problems (DRPs) were also investigated. DESIGN AND METHODS: An observational study was performed on the occurrence and nature of DRPs among elderly patients using at least five drugs, and on the effect of patient-, disease- and treatment-related factors on their occurrence. Proposed and executed interventions were also identified. Data from 318 Dutch pharmacies were analysed using descriptive analyses, logistic regression analyses, Mann-Whitney U tests and chi-squared tests. RESULTS: In total 3,807 CMRs were completed. The mean number of DRPs per patient was 3.0 (standard deviation 2.3), the median was 2 (interquartile range 1-4). Overtreatment and undertreatment were the most frequently occurring DRPs. Multivariate analysis showed that a large number of chronic drugs and a high age increased the number of DRPs. Patients with specific diseases had a higher number of DRPs than patients without that disease. 46.2% of the proposed interventions during a CMR were executed unaltered, while in 23.7% of the cases a different intervention was carried out. CONCLUSION: With CMR, the number of DRPs detected in a daily practice setting was similar to that found in randomised studies. This can also be concluded about the percentage of accepted interventions. Selecting patients with a high age, a high number of chronic drug use and suffering from specific diseases may improve the effectiveness of a CMR.