This is a pilot study for evaluating a drug counselling model and identifying DRPs in outpatient pharmacy. In fact, it was driven by the actual clinical need of effective and standardized pharmacy services in the outpatient pharmacy setting, and the results could feed into decision making pertaining to reducing DRPs, and provide a new angle for development and implement of PC in the process of outpatient drug use.
The results found that “Adverse drug event (possibly) occurring” was the most frequently detected DRP in outpatient pharmacies, excluding patients asking about the method of taking drugs, usage and dosage, and prescription management-related issues. Most DRPs were due to necessary information not provided in dispensing, drug selection, and dose selection, which is in line with previous reports in China20. More than 98.25% of advice given by the pharmacist was accepted or taken into consideration, which was much higher than previously reported in China. This suggests that the drug counseling model implemented by pharmacists in this study is efficient in identifying DRPs in outpatient pharmacies, and the establishment of such practice models can be beneficial to institutions with limited human resources in identifying the majority of DRPs and avoiding medicine errors.
The most frequently encountered DRPs in our study were due to necessary information not provided about drug use. This high frequency is probably related to the limited time of interaction between physicians and patients and patients and dispensing pharmacists21,22. In China, the number of patients is large, but medical resources are limited. When seeing a doctor, patients not only want to be diagnosed and treated by an excellent doctor but also want to further understand the effects of the drugs prescribed by the doctor on them, what adverse reactions may occur, and what problems should be considered when using drugs. In particular, patients with multiple diseases who visit different doctors want to know whether drugs for different diseases interact with each other and whether they can be used together. However, due to the time and professional relationship, the clinician cannot give all the answers to the patients. These situations bring great opportunities for pharmacists.
This allows pharmacists to investigate the patients’ needs so that pharmacists can ‘‘fill in the gaps of knowledge.’’ Most routine patient counseling by pharmacists is typically not time intensive and is considered an intervention to improve medication adherence and consequently minimize noncompliance-related therapy problems.23,24 In China, an imbalance exists in the development of drug counseling models among different specialties and various regions. Most public third-class hospitals have set up drug consultation clinics and charge fees, such as Xi 'an and Chengdu. However, some regions, such as Ningxia, have drug counseling clinics but do not pay for the service. Because drug consultation charging standards and content are not unified in most governmental hospitals in China, this study is expected to provide cornerstone evidence for decision-makers to show the need for implementing drug consultation clinics. Fully evaluating pharmacy consultation services will provide more evidence to ensure the success and benefits of implementing drug consultation clinics in reducing DRPs and improving patient health outcomes.
Pharmacy consultations were designed to cover those populations and their medication therapies, which can guide patients’ drug use under limited hospital resources. Thus, effective means are needed to discover more of both actual and potential DRPs, a finding stimulating further development of counseling models25. These models can both improve and standardize counseling quality, and also to be a means to improve drug use by serving as an important tool to increase the identification and resolution of DRPs. In this study, the drug counseling model was tailored to outpatient pharmacies, and they basically consist of important key questions to be covered routinely in the pharmacy practitioner’s dialog with the patient. The results of this study found that 97% of DRPs could be partially or completely solved in the pharmacy. These results confirm the usefulness of the counseling model as a way to foster DRP detection and resolution in patients in daily practice. In order to ensure that information is given according to the patient’s level of understanding without posing barriers or interference with communication, in this study, the consultants were clinical pharmacists with rich experience and clinical pharmacy training who had obtained clinical pharmacy training certificates from the China Ministry of Health. This underlines clinical pharmacists’ key role in counseling customers on their medication to monitor the use of medicines, identifying DRPs, and intervening when necessary to ensure that customers use medicines safely, appropriately, and effectively.
It firstly in China that we used a drug counseling model at an outpatient pharmacy, and found 504 DRPs under the model developed by an experienced pharmacist team. According to the results, it may be generally applied to other hospitals. However, the study also has some limitations. First, data collection was mostly performed by the leading pharmacist, which may lead to information bias and the possibility of underestimating DRP incidence. Nevertheless, in order to minimize the bias of the study results, three researchers participated in the DRP classification and review among each other. Second, pharmacy consultations are a process of patients' active consultation, and some patients may not choose to consult pharmacists, so the issue of whether the study participants were representative of the wider patient population. In addition, the number of units involved in our study is limited and does not represent the overall level of China, but this study results and methods can provide lessons for the process of setting up pharmacy consultations that concretize guidelines with adjustments and details according to local characteristics.