1.3. The context Global Trends and Challenges in Community Pharmacy As has been pointed out elsewhere, drug

therapy has been proven to prolong life and

increase its quality, and is often more cost

effective and less invasive than surgery and

other medical procedures. However, it has

also contributed to the rising costs of health

care and adverse events2.

Drug-related problems such as adverse

events are not uncommon, and there is

extensive evidence on the high direct and

indirect costs caused by pharmaceuticals 9-13.

Examples from around the world:

A study conducted among older persons in the ambulatory setting

estimated that the overall rate of

adverse drug events was 50.1 per 1000

person-years, with a rate of 13.9

preventable adverse drug events per

1000 person-years. Of the adverse drug

events, 599 (39.0%) were categorized as

serious, life-threatening, or fatal; 244

(42.2%) of these more severe events

were deemed preventable compared

with 199 (19.9%) of the 945 significant

adverse drug events9;

Studies have estimated that 5% to 10% of all hospitalizations are medication-

related, as are a large proportion (4% to

29%) of all emergency department


Adverse events after hospital discharge are also of concern, with 23% of

patients experiencing an adverse event

within 30 days; 50% of these adverse

events were deemed preventable and

92% were due to medications 15;

In a study conducted in 112 community pharmacies in Europe, drug-related

problems were identified in 63.9% of

patients. Uncertainty or lack of

knowledge about the aim or function

of the drug (29.5%) and side effects

(23.3%) were the most common DRPs.

Practical problems were reported by

12.4%. Pharmacists also revealed other

problems (24.0%) concerning dosage,

drug duplication, drug interactions and

prescribing errors. Patients with more

changes in their drug regimens (drugs

being stopped, new drugs started or

dosage modifications) and using more

drugs were more likely to develop


In the United States of America, the overall cost of drug-related morbidity

and mortality exceeded $199.4 billion in

2000. Hospital admissions accounted

for nearly 90% ($121.5 billion) of total

costs, followed by long-term-care

admissions, which accounted for 19%

($32.9 billion)17.

Non-adherence is also a serious concern,

with WHO stating that approximately 50% of

chronic patients do not adhere to therapy18.