Pharmacologic Stewardship in a Rural Community Pharmacy

Abstract

Background: Pharmacotherapy is an essential part of patient care. In order to achieve optimal health outcomes, safe and effective prescribing and administering of medications is crucial, especially since the process of pharmacotherapy can cause serious problems, mainly adverse events and/or interactions, that often pass undetected. Objective(s): To investigate the feasibility of using community pharmacies as checkpoints to detect errors and failures in prescribing, as well as patients’ compliance with pharmacotherapy. To this end, analysis and recording of the prescribing process was carried out and error-prone points were identified. Methods: Patients and caregivers filling prescriptions during the first 4 weeks of November 2017 and February 2018 answered questions in order to evaluate their attendance of regular checkups and their compliance with prescribing instructions. All prescriptions filled at the pharmacy were examined for detection of prescription errors and drug–drug interactions. Statistical analyses, including calculations of the correlation coefficient phi (φ), chi-square, and confidence intervals, were carried out. Detected errors and failures were evaluated by application of the Health Failure Mode Effect Analysis (HFMEA) quality tool. Results: A significant number of patients (16.7%) failed to regularly attend checkups regarding known health problems (95% CI: 10.6–22.7%), a corresponding percentage (16%, 95% CI: 10.1–21.9%) did not comply with prescribed pharmacotherapy, and a significant proportion of patients self-medicated regularly (32%, 95% CI: 24.5–39.5%). A total of 8.6% of prescriptions included medication combinations with a potential for severe drug–drug interactions (95% CI: 7.1–10.2%) while 58.7% of the prescriptions included combinations that could lead to moderate ones (95% CI: 56.1–61.4). The HFMEA indicated that all problems recorded required immediate interventions, except for prescribing errors. Conclusions: Community pharmacies can be potential checkpoints for the detection and evaluation of prescribing errors and pharmacotherapy failures.