Trends in pharmacists' medication order review in French hospitals from 2006 to 2009: analysis of pharmacists' interventions from the Act-IP© website observatory

What is known and objectivesThe French Society of Clinical Pharmacy has developed a website, named Act-IP (c), enabling hospital pharmacists to document and analyse pharmacists' interventions (PIs) proposed during medication order review when a drug-related problem is detected. This study analyses PIs documented in Act-IP (c) and assesses factors associated with physicians' acceptance of PIs. MethodsPIs documented into Act-IP (c) over a 30-month period were analysed. Independent predictors of physicians' acceptance were assessed using multiple logistic regression. Results and discussionA total of 34522 PIs were registered by 201 pharmacists working in 59 hospitals. PIs were mostly related to dose adjustment' (25%), drug discontinuation' (20%) and drug switch' (19%). Of the 43343 medications involved, 28% targeted drugs acting on the central nervous system, 17% anti-infective drugs and 16% cardiovascular drugs. Sixty-eight per cent of PIs were accepted by physicians (15% refusals and 17% non-assessable). Physicians' acceptance was significantly associated with 1/ drug group: antineoplastics and immunomodulators (OR=229, CI 95[194-269]), anti-infectives (OR=119, CI 95 [111-128]); 2/ type of intervention: drug switch (OR=154, CI 95 [143-165]), drug discontinuation (OR=138, CI 95 [129-148]), administration modality optimization (OR=119, CI 95 [111-129]), addition of a new drug (OR=112, CI 95 [100-124]); 3/ ward specialty: paediatrics (OR=183, CI 95 [124-270]) and intensive care (OR=134, CI 95 [110-164]); 4/ level of pharmacist integration in the ward: higher when the pharmacist is regularly in the ward compared with occasionally (OR=074, CI 95 [070-079]) or never (OR=068, CI 95 [060-075]) present. What is new and conclusionThis study highlights the role of routine pharmacist review of medication orders to prevent drug-related problems and gives new insights for a successful collaboration between physicians and pharmacists.