Promoting Appropriate Drug Use Through the Application of the Spanish Drug-Related Problem Classification System in the Primary Care Setting

Background: According to the Second Consensus of Granada (2002), the term drug-related problem (DRP) is defined as a health problem resulting from pharmacotherapy and is considered a negative clinical outcome (ie, a therapeutic objective is not achieved or adverse effects are reported). DRP classification systems used in primary care settings can be useful tools to detect, evaluate, and resolve DRPs. Objective: To encourage appropriate drug use in the ambulatory clinical setting through DRP detection and evaluation by means of the Spanish DRP classification system, and to document how pharmacists can help resolve DRPs through interventions with both general practitioners (GPs) and patients. Methods: Four pharmacists investigated DRPs in polymedicated patients over a 6-month period. All detected DRPs were grouped into 3 major categories: necessity, effectiveness, and safety. To resolve DRPs, pharmacists performed interventions on GPs and patients. GPs received verbal and written information about DRPs; patient interventions were in the form of private meetings on health education. Results: Four hundred twenty-two patients, 80% of whom were aged 65 years or older, were included in the study. Each patient was taking a mean ± SD of 8.1 ± 2.4 medications. Three hundred four medications were associated with 245 DRPs; medications indicated for digestive/metabolic or cardiovascular pathologies were the most prevalent. Most (60%) of the identified DRPs belonged to the effectiveness category, whereas safety issues accounted for 28.6%. The most frequently reported DRP was pathology resistant to treatment (19.6%), followed by nonadherence (16.3%). Of the 215 interventions carried out to resolve these DRPs, 173 (80.5%) were addressed to GPs, who agreed to change therapy regimens on 90.2% of the occasions. Forty-two (19.5%) interventions were addressed to patients. Furthermore, the interventions accepted by GPs and patients resolved 176 (82%) DRPs. Conclusions: The current Spanish DRP classification system is a useful tool to systematically detect and document DRPs in daily general practice, in addition, the interventions addressed by pharmacists to GPs and patients resolved most of the detected DRPs.