Characterization of pharmacist-based medication management services in a community pharmacy.

Background: Medication management (MM) refers to all clinical activities that a pharmacist performs to ensure safe and effective medication therapy for patients.

Objective: To characterize pharmacist-driven MM services via retrospective analysis of real-world data collected in a community pharmacy in British Columbia (BC), Canada.

Methods: This was a retrospective longitudinal study from January 2014-December 2015. Patient demographics, clinical problems, identified drug-related problems (DTPs), and pharmacists' interventions were summarized using descriptive statistics. The relationship between DTPs and the clinical conditions, as well as DTPs and the interventions, were analyzed. Other outcomes included: the relationship between patients' age and visit time with the number of DTPs; the number of clinical conditions; and the number of interventions.

Results: 1,572 patients received MM (mean visit time = 29.1 min). 2,133 DTPs were identified, which resulted in 7176 recommended interventions. The clinical problems most frequently encountered were cardiovascular (20%), and mental (15.7%). The most frequently identified DTP was "needs additional therapy" (61.8%), while the most frequently initiated or recommended interventions were education (43.4%), and changing therapy (21.6%). Elderly patients with multiple comorbidities had more DTPs and required more interventions and even when no DTPs were identified, some patients still received counselling and education in these visits.

Conclusion: Using real-world data, this research demonstrated that patients benefit from identification and resolution of DTPs through pharmacists-driven MM programs.