TABLE 1.
Types of irrational drug uses and DTC interventions.
| The cause | Frequency (%) | ||||||
|---|---|---|---|---|---|---|---|
| 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | |
| C1 Drug selection | |||||||
| C1.1 Inappropriate drug according to guidelines/formulary | 39 (13.59) | 32 (13.28) | 29 (14.36) | 27 (15.34) | 24 (16.44) | 18 (15.93) | 16 (19.51) |
| C1.2 Inappropriate drug (within guidelines but otherwise contra-indicated) | 22 (7.67) | 17 (7.05) | 15 (7.43) | 11 (6.25) | 9 (6.16) | 6 (5.31) | 2 (2.44) |
| C1.3 No indication for drug | 23 (8.01) | 17 (7.05) | 15 (7.43) | 12 (6.82) | 11 (7.53) | 10 (8.85) | 6 (7.32) |
| C1.4 Inappropriate combination of drugs, drugs and herbal medications, or drugs and dietary supplements | 31 (10.8) | 29 (12.03) | 24 (11.88) | 21 (11.93) | 17 (11.64) | 13 (11.5) | 9 (10.98) |
| C1.7 Too many drugs prescribed for indication | 33 (11.5) | 31 (12.86) | 27 (13.37) | 21 (11.93) | 16 (10.96) | 12 (10.62) | 8 (9.76) |
| C3 Dose selection | |||||||
| C3.1 Drug dose too low | 9 (3.14) | 7 (2.90) | 8 (3.96) | 6 (3.41) | 5 (3.42) | 5 (4.42) | 4 (4.88) |
| C3.2 Drug dose too high | 22 (7.67) | 18 (7.47) | 16 (7.92) | 15 (8.52) | 11 (7.53) | 9 (7.96) | 7 (8.54) |
| C3.3 Dosage regimen not frequent enough | 12 (4.18) | 7 (2.9) | 6 (2.97) | 6 (3.41) | 4 (2.74) | 2 (1.77) | 2 (2.44) |
| C3.4 Dosage regimen too frequent | 33 (11.50) | 28 (11.62) | 21 (10.40) | 17 (9.66) | 14 (9.59) | 9 (7.96) | 8 (9.76) |
| C4 Treatment duration | |||||||
| C4.1 Duration of treatment too short | 22 (7.67) | 16 (6.64) | 9 (4.46) | 8 (4.55) | 6 (4.11) | 6 (5.31) | 6 (7.32) |
| C4.2 Duration of treatment too long | 23 (8.01) | 22 (9.13) | 18 (8.91) | 17 (9.66) | 15 (10.27) | 11 (9.73) | 7 (8.54) |
| C9 Other | |||||||
| C9.1 No or inappropriate outcome monitoring (incl. Therapeutic drug monitoring) | 18 (6.27) | 17 (7.05) | 14 (6.93) | 15 (8.52) | 14 (9.59) | 12 (10.62) | 7 (8.54) |
| Total | 287 | 241 | 202 | 176 | 146 | 113 | 82 |
| DTC Interventions | |||||||
| I1 At prescriber level | |||||||
| I1.1 Prescriber informed only | 82 (28.57) | 50 (20.75) | 33 (16.34) | 29 (16.48) | 24 (16.44) | 17 (15.04) | 15 (18.29) |
| I1.2 Prescriber asked for information | 55 (19.16) | 34 (14.11) | 25 (12.38) | 20 (11.36) | 15 (10.27) | 14 (12.39) | 12 (14.63) |
| I1.3 Intervention proposed to prescriber | 78 (27.18) | 99 (41.08) | 88 (43.56) | 84 (47.73) | 72 (49.32) | 64 (56.64) | 41 (50) |
| I1.4 Intervention discussed with prescriber | 72 (25.09) | 58 (24.07) | 56 (27.72) | 43 (24.43) | 35 (23.97) | 18 (15.93) | 14 (17.07) |
| I3 At drug level | |||||||
| I3.1 Drug changed to … | 86 (29.97) | 79 (32.78) | 52 (25.74) | 45 (25.57) | 37 (25.34) | 32 (28.32) | 27 (32.93) |
| I3.2 Dosage changed to … | 52 (18.12) | 48 (19.92) | 47 (23.27) | 42 (23.86) | 34 (23.29) | 24 (21.24) | 17 (20.73) |
| I3.3 Formulation changed to … | 22 (7.67) | 19 (7.88) | 29 (14.36) | 23 (13.07) | 22 (15.07) | 18 (15.93) | 12 (14.63) |
| I3.4 Instructions for use changed to … | 34 (11.85) | 27 (11.2) | 16 (7.92) | 12 (6.82) | 8 (5.48) | 8 (7.08) | 6 (7.32) |
| I3.5 Drug paused or stopped | 49 (17.07) | 38 (15.77) | 30 (14.85) | 28 (15.91) | 21 (14.38) | 17 (15.04) | 10 (12.2) |
| I3.6 Drug started | 44 (15.33) | 30 (12.45) | 28 (13.86) | 26 (14.77) | 24 (16.44) | 14 (12.39) | 10 (12.2) |
| Intervention Acceptance | |||||||
| A1 Intervention accepted | 227 (79.09) | 197 (81.74) | 171 (84.65) | 151 (85.8) | 131 (89.73) | 105 (92.92) | 78 (95.12) |
| A1.1 Intervention accepted and fully implemented | 121 (42.16) | 113 (46.89) | 110 (54.46) | 115 (65.34) | 119 (81.51) | 92 (81.42) | 72 (87.8) |
| A1.2 Intervention accepted, partially implemented | 49 (17.07) | 52 (21.58) | 40 (19.80) | 23 (13.07) | 8 (5.48) | 8 (7.08) | 2 (2.44) |
| A1.3 Intervention accepted but not implemented | 57 (19.86) | 32 (13.28) | 21 (10.4) | 13 (7.39) | 4 (2.74) | 5 (4.42) | 4 (4.88) |
| A2 Intervention not accepted | 60 (20.91) | 44 (18.26) | 31 (15.35) | 25 (14.2) | 15 (10.27) | 8 (7.08) | 4 (4.88) |
| A2.1 Intervention not accepted: not feasible | 31 (10.8) | 26 (10.79) | 22 (10.89) | 17 (9.66) | 10 (6.85) | 6 (5.31) | 3 (3.66) |
| A2.2 Intervention not accepted: no agreement | 29 (10.10) | 18 (7.47) | 9 (4.46) | 8 (4.55) | 5 (3.42) | 2 (1.77) | 1 (1.22) |
| Status of the drug-related problem | |||||||
| O1 Problem solved | 138 (48.08) | 133 (55.19) | 125 (61.88) | 118 (68.1) | 115 (78.77) | 90 (79.65) | 66 (80.49) |
| O2 Problem partially solved | 32 (11.15) | 32 (13.28) | 25 (12.38) | 20 (10.43) | 12 (8.22) | 10 (8.85) | 8 (9.76) |
| O3 Problem not solved | 117 (40.77) | 76 (31.54) | 52 (25.74) | 38 (21.47) | 19 (13.01) | 13 (11.50) | 8 (9.76) |
C: causes, I: interventions, A: acceptance, O: Status of the drug-related problem.