Identification and classification of causes of drug-related problems

Abstract

Aim To facilitate the identification and classification of causes of DRPs, as part of the medication review process. Objectives (1) To develop and validate a set of prescribing-appropriateness criteria for use in older Australians (2) To develop and validate a classification system for causes of DRPs (3) To assess the impact of applying the prescribing appropriateness criteria-set, during medication review, on change in the number of criteria met and on health related quality of life (4) To determine the implementation rate of medication review recommendations by general practitioners (GPs) and the number and type of (potential) causes of a DRP identified by application of our classification system. Key findings A validated criteria-set resulted in a list of 41 criteria. A literature review found that three quarters of classification studies had modified an existing classification system or developed their own. An aggregated system for classifying causes of DRPs was developed and validated. A randomised controlled trial showed that 76.4% of DRPs found at medication review were identified by the criteria-set. The aggregated classification system identified all causes of DRPs. Conclusions An integrated three-dimensional approach to reduce morbidity and mortality caused by DRPs in older people was proposed, consisting of a mechanism for detecting the problem (prescribing-appropriateness criteria), for determining the cause of the problem (through comprehensive medication review) and for describing (or classifying) the problem in terms which might be universally acceptable