MCQs in Clinical Pharmacy Edited is an invaluable study aid for those preparing for multiple choice questions in clinical pharmacy
The healthcare systems of most industrialised nations have a problem that needs the attention of pharmacists, if it is to be solved correctly. The problem is the poor quality of medicines use, and the solution includes increased pharmacist participation in medicines management.
Studies from many nations, conducted over many years, have shown the need for better management of drug therapy. This first became clear from ‘process’ studies showing some inappropriate prescribing, inadequate monitoring and advice, and patient nonadherence. Other studies took this a step further, and confirmed not only the prevalence of adverse outcomes of drug therapy, but also that such adverse outcomes often could have been prevented by more careful management. For example, the median preventability rate in one review was 59%.
Mis-managed drug therapy may rank as one of the leading causes of hospital admission, because of adverse reactions, undertreatment, or non-treatment. The median rate of hospital admissions from preventable drug-related morbidity (PDRM)* in that review was 4.3%. This would rank PDRM with cancer, coronary heart disease, diabetes mellitus and asthma as a leading cause of hospital admissions in many countries. The rate of adverse outcomes among inpatients typically was 1.5%, and adverse drug events may prolong hospital stays by 2–4 days.
The possibilities of safer and more effective drug therapy have been clear, and evidence has been mounting about how to improve them. When pharmacists systematically cooperate with patients and other healthcare providers, with the objective of improving the outcomes of drug therapy, outcomes often improve and costs often decrease.
The road to medicines management has not been like a broad, smooth motorway. Parts of it are, so to speak, unpaved and even unmarked. After nearly two decades of effort by practice researchers, practitioners and pharmaceutical societies throughout Europe and North America, some national programmes, for example, in the USA and the UK, have in effect recognised the need for pharmacists to participate fully in cooperative patient-centred systems. Success on the road ahead will require commitment, planning and effort.
How should pharmacists direct their efforts? Despite the conventional wisdom, prescribing problems are not the leading cause of preventable, drug-related hospital admissions. About 70% of such admissions involved some aspect of the management of ongoing drug therapy. Management of therapy included follow-up monitoring and detection of therapeutic problems, for example, treatment failures, laboratory tests not being done or not being acted upon, and moderate adverse drug reactions that were allowed to become so severe that they necessitated admission. Problems with prescribing, including drug choice, dosage and route accounted for about 16%; drug distribution and administration, including patient non-adherence, accounted for about 13%. Among inpatients, the situation was roughly the opposite: most problems involved prescribing and the fewest involved follow up.