Evaluation of a Screening Questionnaire to Identify Patients at Risk of Drug Therapy Problems in Community Pharmacies

Abstract

Context: Suboptimal drug use is a major contributor to adverse patient outcomes in primary care. Considering their accessibility and frequent interactions with patients, community pharmacists may be well suited to identifying patients who are at high risk of drug therapy problems (DTPs) and who may benefit from a comprehensive medication assessment.

Objective: To determine if a short screening tool can identify patients at risk for DTPs in a community pharmacy setting.

Design: A five question self-administered screening tool was identified in the literature and adapted to reflect current practice in community pharmacy. Adults requesting a refill prescription from three different community pharmacies over 12 weeks completed the screening tool, and had a comprehensive medication assessment with a pharmacist. Information from the assessment was used to: a) determine the ability of patients to correctly answer the screening tool questions and to classify themselves into the appropriate risk category (High or Low Risk); b) compare the number of DTPs identified in each risk category (High vs Low); and c) determine the number of High Risk and Low Risk patients who would qualify for any of the existing provincial medication review programs in Canada.

Results: 49 patients completed the study. Most patients were able to answer the questions on the screening tool correctly. The strength of agreement was very good (Kappa 0.91, p<0.01) between the overall patient determined risk category and pharmacist determined risk category. Patients identified as High Risk (n=18) had a mean of 3.72 (p<0.01) more DTPs than Low Risk patients (n=31). All but one (94.4%) of the High Risk patients had at least one Moderate or Severe DTP, while less than half (48.4%) of Low Risk patients had at least one Moderate or Severe DTP. The majority of High Risk patients were eligible for medication reviews in all programs except for Newfoundland and Labrador, New Brunswick and Saskatchewan. Close to a third of Low Risk patients were eligible for medication reviews in Prince Edward Island, Nova Scotia and Ontario.

Conclusions: This screening tool is a trustworthy method for identifying patients in community pharmacies who have a large number of DTPs. Patients identified as High Risk using this screening tool may be good targets for community pharmacy based comprehensive medication assessments.