Objective  

To investigate pharmacist contribution in the therapeutic hospital team by studying drug-related problems (DRPs), pharmacist therapy advice and consequences of the advice.

Methods  

From May to December 2002, 827 patients in five Norwegian hospitals were included in the study. Demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors were recorded prospectively at the wards.

Main outcome measure  

DRPs, patients characteristics, pharmacist advice to physicians, nurses or patients, response to the pharmacist advice, and reasons (stated by the pharmacist) for not discussing an identified DRP, were reported. An independent quality assessment team retrospectively assessed the DRPs for a randomly selected number of the study population.

Results  

On average 2.6 DRPs per patient were found. A total of 2128 DRPs were registered and of these 1583 (74%) DRPs were brought up for discussion. Physician immediate acceptance rates varied from 80% (for extremely important clinically signififcant DRPs) to 50% (for DRPs of minor clinical significance). High age, use of many drugs at admission, existence of many DRPs and many clinical/pharmacological risk factors for DRPs were associated with low immediate acceptance rate. Type of DRP influenced how the DRP was discussed; adverse drug reaction (ADR) and unnecessary drug were discussed with physicians while e.g. medical chart error and need for patient education were discussed with nurses/patients. Reasons for not discussing DRPs in the team were: not given priority (37%), no longer relevant (31%) and others (31%). DRPs of minor clinical significance were most often excluded from discussion (37%) as opposed to 14% and 22% of those of moderate and major clinical significance.

Conclusions  

The majority of patients had one or more DRPs. The problems identified as DRPs by the pharmacists were accepted as such by the physicians and to a high degree acted upon. Both clinical significance of the DRP and patient characteristics influenced physician immediate acceptance rate. Some DRPs could be solved by direct contact with nurses or the patients. Awareness of DRPs increases through participation of pharmacists in the multidisciplinary therapeutic hospital team.