Evaluation of Clinical Pharmacist Interventions on Drug-Related Problems in an Outpatient Pharmacotherapy Clinic: A Prospective Structured Follow-Up Study

Evaluation of Clinical Pharmacist Interventions on Drug-Related Problems in an Outpatient Pharmacotherapy Clinic: A Prospective Structured Follow-Up Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Clinical Pharmacist Interventions on Drug-Related Problems in an Outpatient Pharmacotherapy Clinic: A Prospective Structured Follow-Up Study Fatemeh Gholami, Bita Shahrami, Elham Hadidi, Farhad Najmeddin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7724048/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Drug-related problems (DRPs) are prevalent in outpatient settings and may result in adverse drug reactions and medication errors. Pharmacists are crucial in identifying and resolving DRPs, particularly for patients with chronic conditions and those on multiple medications. This study assessed the impact of pharmacist interventions on identification and resolution of DRPs, focusing on their prevalence, effectiveness, and acceptance by patients and physicians. Methods This prospective interventional study included adult patients with at least one chronic condition and two or more long-term medications. DRPs were identified through comprehensive medication reviews and categorized using the DOCUMENT classification system. Interventions were provided by clinical pharmacists, and outcomes were assessed at two structured follow-ups: a telephone follow-up at two weeks and an in-person visit at four weeks. Results A total of 411 DRPs were identified, with undertreated indications (32.6%), education/information gaps (13.9%), and monitoring issues (13.1%) being the most common ones. The prevalence of DRPs was higher in males than females (5.1 vs. 3.3, P = 0.002). Pharmacists implemented 411 interventions, with 75.1% directed at patients and 24.8% involving referrals to physicians. The overall acceptance rate was 68.3% for patient-related interventions and 50% for physician-related interventions. Conclusion Pharmacist-led interventions in outpatient care significantly contributed to the identification and partial resolution of DRPs. Structured follow-up visits and patient education improved medication safety and highlighted the value of integrating clinical pharmacists into routine outpatient care.. Drug-Related Problem (DRP) Medication Therapy Management (MTM) Pharmacotherapy Out-Patient Service Pharmacist’s Intervention Introduction Drug-related problems (DRPs) are a major challenge in medication therapy, which, although intended to improve patient quality of life, can lead to adverse outcomes when not properly managed ( 1 ). DRPs are defined as events or circumstances involving drug therapy that interfere with desired health outcomes and can occur at any stage from prescribing to administration ( 2 ). They are categorized into two types: intrinsic toxicity, which relates to the drug’s own pharmacological properties and results in adverse drug reactions (ADRs), and extrinsic toxicity, which results from inappropriate drug use, leading to medication errors and DRPs ( 3 , 4 ). Polypharmacy is another significant contributor to DRPs, making medication management even more complex ( 6 ). Many DRPs, particularly those caused by medication errors, are preventable with timely and effective intervention ( 5 ). Medication therapy management serves as a key strategy for providing clinical pharmacy services and preventing these problems. Clinical pharmacy has expanded from simple drug distribution to offering consultation and direct involvement in patient care, which helps optimize medication therapy and promotes better health outcomes ( 7 ). The establishment of outpatient clinics led by pharmacists represents a shift from traditional product-based pharmacy models to patient-centered care. These clinics focus on preventing and resolving medication therapy problems, ensuring more effective and safer treatment ( 8 ). This study aimed to evaluate the impact of clinical pharmacist interventions on the identification and resolution of DRPs in an outpatient pharmacotherapy clinic. Specifically, it assessed the prevalence and types of DRPs, the acceptance of pharmacist recommendations by patients and physicians, and the outcomes of these interventions over two structured follow-up visits. By focusing on a prospective outpatient setting, this study contributes to the evidence supporting the integration of pharmacist-led services to enhance medication safety and optimize patient care. Methods Study design and participants This prospective interventional study was performed in duration of six months at the 13-Aban Pharmacotherapy Clinic affiliated with Tehran University of Medical Sciences (TUMS). This study was approved by the ethics committee of TUMS and Deputy of research with no fund provided. (IR.TUMS.PSRC.REC.1396.3379). Individuals aged 18 years and above with at least one chronic condition and a regimen of at least two long-term medications, whether prescribed or over-the-counter, were included in the study. Participants who failed to attend scheduled follow-up visits were excluded. Data collection Eligible patients underwent a comprehensive review of their medical history at the time of admission into the study. For each patient, a medical record was created that included demographic data, laboratory results, and paraclinical findings. In the first visit, DRPs were identified by a thorough review of medication history. An individualized care plan was developed for each patient, including pharmacist recommendations and, when necessary, referral back to the physician for further evaluation or treatment modification. Two structured follow-ups were planned: A telephone follow-up at two weeks after the initial visit to assess the implementation of recommendations and detect any new or unresolved DRPs. A final in-person follow-up at one month, which served as the study endpoint, to reassess the types, frequency, and evolution of DRPs. This one-month endpoint was selected to allow for a standardized and practical evaluation of short-term outcomes in the outpatient setting. Patients with unresolved or newly identified DRPs at the final visit were referred for further clinical care as appropriate. Interventions for managing DRPs To handle the detected DRPs, the clinical pharmacist implemented as patient-related or physician-related interventions. These interventions were performed by a board-certified clinical pharmacotherapy specialist (known as clinical pharmacist) with the assistance of a PharmD student. For patient-related interventions, recommendations were provided verbally and in writing, recorded in the patient's file and their medication list. For physician-related interventions, referrals were made through written letters. Study outcomes The outcomes of this study were to identify the most common DRPs and their subtypes, as well as to assess the frequency of DRPs across different drug classes. Furthermore, the study aimed to explore the level of acceptance of interventions by both patients and physicians and the relationship between DRPs and possible risk factors such as the age and gender of patients. The primary outcome was the clinical benefit and resolution of DRPs through serial follow-up visits, which enabled dynamic monitoring and intervention adjustments. Identification, classification, and analysis of DRPs Reliable and up-to-date scientific resources, were used to identify DRPs. After identifying DRPs, they were categorized using the revised DOCUMENT system ( 9 ), which classifies DRPs into eight main categories, each further divided into various subcategories. Anatomical Therapeutic Chemical (ATC) classification codes ( 10 ) were used to define associations between causes in the therapeutic group and specific DPRs. These codes provide a standardized system for classifying drugs according to their anatomical structure, therapeutic effects, and chemical properties. Patient adherence and physician acceptance Patient adherence was defined as the extent to which patients followed the recommended changes to their medication regimen, lifestyle, or monitoring plans as advised during the clinical pharmacist consultations. Physician acceptability referred to the physician's agreement with and implementation of the pharmacist's recommendations, including medication changes, referrals, or further diagnostic evaluations. A score of 1 was given when the patient or physician accepted the recommendation or intervention, and a score of 0 when it was not accepted. The acceptance percentage of both patient-related and physician-related interventions was calculated based on the number of accepted interventions divided by the total number of interventions requiring follow-up. Statistical analysis The statistical analyses were carried out using the IBM SPSS Statistics software package, version 25.0 (IBM Corp, New York, USA). Nominal data were described as percentages and frequencies, and quantitative data were described as mean ± standard deviation (SD) for normally distributed data, or as median and range for non-normally distributed data. The Kolmogorov-Smirnov test was used to assess the normality of the data. The student’s t-test and analysis of variance (ANOVA) were used to compare the means. The Pearson correlation and Kendall's tau-b tests were applied to define correlations for normal and non-normal distributions, respectively. Results Of all the patients referred to Pharmacotherapy clinic to review their DRPs, 57 met the inclusion criteria. The demographics and baseline characteristics are summarized in Table 1. Table 1: Demographics and baseline characteristics Variable Participants Age (mean ± SD), total Male Female 61.67 ± 11.30 62.5 ± 11.9 60.5 ± 10.5 Male/Female 34 (59.60%)/23 (40.40%) Number of diseases or conditions (mean ± SD) 6.68 ± 2.60 Number of medications used (mean ± SD) 9.53 ± 3.62 Number of medications associated with DRP (mean ± SD) 2.14 ± 1.68 Data are presented as mean ± standard deviation, or number of participants (%) A total of 687 diseases were identified among the patients. The most frequently observed diseases in this study, in order of prevalence, were hypertension (N = 96, 48%), diabetes mellitus (N = 73, 36.5%), hyperlipidemia (N = 60, 30%), and ischemic heart disease (N = 45, 22.5%). In 18 (32%) patients, the majority of DRPs were identified during the first visit, with only a few more DRPs detected during the second and third visits. In 11 (19%) patients, the majority of DRPs were identified within two visits. However, 28 (49%) patients still had many DRPs detected by the third visit. Prevalence and characteristics of DRPs A total of 411 DRPs were identified during three distinct visits among the participants. The average frequency of DRPs in each visit is shown in Table 2. The most common types of DRPs were undertreated indications (32.6%), education and information (13.9%), monitoring (13.1%), and drug selection (12.9%). The most common subtypes of DRPs included the need for preventive treatment (18.2%), monitoring through laboratory tests (9.5%), and the presence of untreated symptoms and conditions (8.8%). The prevalence of various types and subtypes of DRPs is summarized in Table 3. Table 2: Average drug-related problems in each visit Occasion of visit Average number of DRPs First visit 4.37 Second visit 1.60 Third visit 2.78 Total 7.21 DRPs: Drug-related problems Table 3: Prevalence of various types and subtypes of DRPs DRPs types and subtypes* Number (%) Drug selection Duplication Drug interaction Wrong dosage form Wrong potency Contraindication No indication Availability of more effective drugs 4 (1.0) 9 (2.2) 3 (0.7) 1 (0.2) 4 (1.0) 25 (6.1) 7 (1.7) Over or underdose prescribed Dose too high Dose too low Incorrect or unclear frequency, schedule, or duration Other dose problems 11 (2.7) 11 (2.7) 13 (3.2) 2 (0.5) Compliance Taking too little Taking too much Irregular drug intake Difficulty using dosage form Concern about side effects Lack of understanding of proper use Unwillingness to take medication 4 (1.0) 0 (0.0) 10 (2.4) 2 (0.5) 1 (0.2) 3 (0.7) 9 (2.2) Undertreated indications Condition not adequately treated Condition indicating undertreated Preventive therapy required Other untreated indication problem 20 (4.9) 36 (8.8) 75 (18.2) 3 (0.7) Monitoring Laboratory monitoring Non-laboratory monitoring Other monitoring problem 39 (9.5) 12 (2.9) 3 (0.7) Education or information Patient drug information request Disease management or advice Confusion about therapy Demonstration of device Other education or information problem 17(4.1) 22 (5.4) 9 (2.2) 8 91.9) 1(0.2) Non-clinical Drug unavailability High drug cost relative to patient income Difficulty obtaining a specific drug brand Lack of access to drugs in the patient’s location 8 (1.9) 7 (1.7) 1 (0.2) 3 (0.7) Toxicity or adverse drug reaction Problem caused by drug interaction Apparent toxicity with a suspected drug-related cause Toxicity evident Drug-drug interaction Other toxicity problem 7 (1.7) 1 (0.2) 13 (3.2) 1 (0.2) 6 (1.5) DRPs: Drug related problems *According to DOCUMENT system Distribution of the revised ATC codes for drugs causing DRPs Distribution of the revised ATC codes for drugs causing DRPs is shown in Table 4. Since some DRPs were not associated with a specific drug, another category called "unrelated to a specific drug" was added to the ATC codes. This category included the highest number of DRPs (N = 133), and the most frequently reported DRPs in this category were related to monitoring (N = 51). Besides this category, the most common DRPs associated with specific diseases were as follows: alimentary tract and metabolism (N = 82), anti-infectives for systemic use (N = 66), and cardiovascular system (N = 60). In the first two categories, the principal causes of DRPs were undertreated indications (N = 33 and N = 52, respectively), and in the third category, the leading cause was over or under dosage (N = 23). Table 4: Distribution of the revised-ATC codes in DRPs DRPs* Revised-ATC codes Total A 1 B 2 C 3 D 4 G 5 H 6 J 7 L 8 M 9 N 10 P 11 R 12 S 13 U 14 V 15 D 18 2 14 0 2 1 2 1 5 3 0 1 0 3 1 53 O 10 1 23 0 1 0 0 0 1 1 0 0 0 0 0 37 C 8 8 4 0 0 1 1 1 1 2 0 1 0 1 1 29 U 33 2 10 0 0 0 52 0 0 3 0 0 0 33 1 134 M 0 0 1 1 0 0 0 0 0 1 0 0 0 51 0 54 E 8 3 1 0 2 1 3 0 1 2 0 4 0 31 1 57 N 2 2 2 0 1 0 7 0 0 2 0 0 0 3 0 19 T 3 1 5 1 2 0 1 0 0 3 0 0 1 11 0 28 Total 82 19 60 2 8 3 66 2 8 17 0 6 1 133 4 411 ATC: Anatomical therapeutic chemical DRPs: Drug related problems *According to DOCUMENT system [1] Alimentary tract and metabolism 2 Blood and blood-forming organs 3 Cardiovascular system 4 Dermatologicals 5 Genitourinary system and sex hormones 6 Systemic hormonal preparations, excl. sex hormones and insulins 7 Anti-infectives for systemic use 8 Antineoplastic and immunomodulating agents 9 Musculoskeletal system 10 Nervous system 11 Antiparasitic products, insecticides and repellents 12 Respiratory system 13 Sensory organs 14 Unrelated to a specific drug 15 Various Factors associated with DRPs The correlation between DRPs and variables such as age (P = 0.963), number of comorbidities (P = 0.283), total number of medications (P = 0.499), and adherence to treatment regimens (P = 0.523) were not significant. However, a significant correlation was found regarding gender. The prevalence of DRPs was higher in males, averaging 5.1 compared to 3.3 in females (P = 0.002). Clinical pharmacist interventions Altogether, 411 interventions were carried out for each identified DRP across the three visits. Among these, 102 (24.8%) interventions were related to referral letters written to physicians, and 309 (75.1%) interventions were related to oral and written advice and education given to patients. These interventions were done according to intervention protocol listed by the clinic and their distribution in DRPs (Table 5). The most common interventions were referral to physicians (N = 102), over-the-counter (OTC) medication prescribing (N = 76), and education (N = 70). The most frequent DRPs associated with these interventions were undertreated conditions for “referrals to physicians” and “OTC medication prescribing” categories (N = 54 and 65, respectively), and education or information (N = 33) for “education” category. Table 5: DRPs distribution in clinic’s intervention protocol Interventions DRPs Total D O C U M E N T Referral to MD 20 9 4 54 8 2 1 4 102 Prescribing OTC 4 1 0 65 0 1 4 1 76 Education 0 0 2 9 13 33 3 10 70 Laboratory test prescription 0 0 0 2 32 1 0 2 37 Counselling 0 3 13 0 1 15 0 0 32 Dosing 1 18 4 4 0 0 0 4 31 Indication 19 1 0 0 0 0 0 1 21 Administration 0 5 4 0 0 5 0 0 14 Availability 0 0 0 0 0 0 10 0 10 Interaction 7 0 0 0 0 0 0 3 10 Side effect 0 0 2 0 0 0 0 2 4 Therapeutic substitution 2 0 0 0 0 0 1 0 3 Product identification 0 0 0 0 0 0 0 1 1 Total 53 37 29 134 54 57 19 28 411 DRPs: Drug-related problems MD: Doctor of Medicine OTC: Over-the-counter Patient adherence and physician acceptance The acceptance rate for patient-related interventions was 68.3%. In the first follow-up, 170 out of 249 (68.2%) interventions and in the second follow-up, 33 out of 48 (68.75%) interventions were accepted by patients. The highest acceptance rate among DRP categories was for education or information interventions (85.7%), while the lowest acceptance rate was for undertreated interventions (58.8%). During the two follow-ups, a total of 73 referral interventions to physicians were documented. Of these, patients presented 50 referral letters to physicians, and 25 of these were accepted, leading to an acceptance rate of 50% among the physicians. Table 6 provides details concerning the acceptance rates of both patients and physicians. Table 6: Acceptance rates of patients and physicians Follow-up visit Number of interventions performed Physician-dependent interventions N (%) Patient-dependent interventions N (%) First (by phone) 249 64 (25.7) Interventions delivered to physician: 46 (71.8) 185 (74.2) Interventions accepted by patient: 124 (67.0) Interventions accepted by physician: 23 (50.0) Second (in-person) 48 9 (18.75) Interventions delivered to physician: 4 (44.4) 39 (81.2) Interventions accepted by patient: 29 (74.3) Interventions accepted by physician: 2 (50.0) Discussion This study demonstrated the important role of pharmacist intervention in addressing DRPs in outpatient care and highlighted its importance in improving patient outcomes and medication safety. The results showed an average of 4.37 DRPs per patient during the initial visit, which is comparable to that reported in other studies ( 11 , 12 , 13 ). However, this average was higher than the average DRPs reported by Xin Wang et al. and Haugbølle et.al. ( 14 , 12 ). This difference might be due to the fact that patients in this study were taking a higher number of medications, or it could be that only patients experiencing DRPs sought care at our clinic. In this study, the most frequently identified DRPs were undertreated indications, education or information, and drug selection. In studies that classified the DRPs in a similar way to ours, drug selection, toxicity or ADR, undertreated indications, and non-compliance were reported as frequently detected DRPs ( 11 , 13 ). Additionally, the most common subtypes of DRPs identified in this study were preventative therapy required, laboratory monitoring, and undertreated conditions. In other studies, patient requests for drug information and untreated conditions were the most common subtypes ( 13 ). Based on these findings, it can be assumed that patients often lack adequate awareness of their medical conditions and medications. Many patients do not receive the essential information they need about their medications, which can hinder pharmacotherapy outcomes ( 15 ). The most commonly associated drugs with DRPs, based on their ATC codes, included those related to the alimentary tract and metabolism, anti-infectives for systemic use, and cardiovascular system. In a similar study, the most common categories were alimentary tract and metabolism, cardiovascular system, and nervous system ( 13 ). Additionally, other findings indicated that the cardiovascular system was the most frequently reported category, as with other studies ( 11 , 16 ). These results highlight the necessity for identifying high-risk drugs, and the importance of educating and counseling patients. They also suggest the establishment of specialized centers to identify and manage DRPs. Regarding the risk factors related to the prevalence of DRPs, the only factor found to be associated with DRPs was gender, with a higher prevalence in men compared to women. In another study conducted in our clinic, DRPs also showed associations with gender ( 14 ). In contrast, other studies have shown an opposite pattern ( 11 , 17 ). Also, a study conducted by Garin N et al. pointed out that factors such as polypharmacy were associated with the prevalence of DRPs ( 18 ). The significant association with the male gender observed in our study could be due to the social structure of clients coming to this pharmacotherapy clinic, with a higher percentage of male clients. After conducting two follow-ups in this study, a significant number of patients still had unresolved DRPs, indicating that more than two follow-ups were necessary to fully identify and resolve all DRPs in patients. Another study conducted by Wung JC et al. also showed that a large number of DRPs remain unresolved even after a long-term follow-up ( 19 ). Interestingly, although the number of DRPs decreased after the first intervention (from visit 1 to 2), a moderate increase was observed during the third visit. This rise is likely due to the emergence of new clinical issues, disease progression, or patients not fully adhering to previous recommendations. These findings highlight the dynamic and evolving nature of DRPs in outpatient care and underscore the importance of continued pharmacist involvement over time. This study demonstrated that most of the interventions were accepted by the patients. The main issue patients face appears to be a lack of knowledge about their medications and medical conditions. Therefore, many DRPs could be prevented if healthcare teams provided thorough explanations about medications and patients' conditions before starting treatment, ensuring that patients fully understood the recommendations given to them. Additionally, the level of acceptance among physicians regarding the recommendations in this study was significantly lower than that reported in similar studies ( 20 , 21 , 22 , 23 ). This discrepancy could be attributed to the fact that recommendations in this study were mainly delivered in a written form, whereas another study suggested that indirect communication with physicians might decrease the acceptance of such recommendations ( 20 ). In other comparable studies conducted in hospital settings, pharmacists often had face-to-face interactions with physicians, which yielded a better acceptance rate ( 21 , 22 , 23 ). This study had several limitations that should be acknowledged. First, although the study design included two structured follow-ups to assess the outcomes of pharmacist interventions, it became evident that two follow-ups may not be sufficient to identify and resolve all drug-related problems (DRPs), especially those that emerge later due to disease progression, new prescriptions, or incomplete adherence. A longer follow-up period with additional visits could have provided a more comprehensive evaluation of DRP resolution and sustained clinical benefits. Second, the sample size was relatively limited, and participants were recruited from a single outpatient pharmacotherapy clinic affiliated with a university hospital. This may reduce the generalizability of the findings to broader outpatient populations, especially in rural or non-academic settings. Third, loss to follow-up was a potential source of bias, as patients who did not complete both follow-up visits were excluded from the final analysis. This may have introduced selection bias if those lost to follow-up had different DRP profiles or outcomes than those who remained. Fourth, the classification of DRPs was based on the revised DOCUMENT system, which, although widely used in some studies, may not be as comprehensive or standardized for international comparisons as newer systems like the Pharmaceutical Care Network Europe (PCNE) classification. ( 24 ) Future studies could benefit from using more universally adopted frameworks to improve comparability and precision. Lastly, the intervention delivery method particularly the written communication to physicians may have limited the acceptance of pharmacist recommendations. In-person or real-time collaborative discussions might have enhanced interdisciplinary engagement and increased the implementation rate of clinical suggestions. Conclusion DRPs are prevalent among patients with chronic conditions and require specialized, continuous care for effective management. This study highlights the critical role of clinical pharmacist-led follow-up visits, which not only facilitate early detection and resolution of DRPs but also support sustained improvements in medication safety. The structured follow-up process including individualized education, counseling, and timely interventions resulted in high acceptance rates and a notable reduction in DRPs over time. Effective history-taking, clear communication, and appropriate use of OTC treatments and specialist referrals further enhanced outcomes. These findings support the integration of clinical pharmacist-led follow-ups into routine outpatient care to promote safer and more effective pharmacotherapy, even within short-term intervention frameworks. Abbreviations DRPs drug-related problems ADRs adverse drug reactions OTC over-the-counter PCNE pharmaceutical care network Europe Declarations Informed consent was obtained from all participants. The form is attached as a PDF. The ethics approval certificate is also attached as a PDF. This study was approved by the ethics committee of TUMS and Deputy of research with no fund provided. (IR.TUMS.PSRC.REC.1396.3379) Consent for publication Consent is granted for the publication of this article. Competing Interests We declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding This research did not receive funding. Author Contribution The contribution of the authors for this manuscript is as follows: Dr. Javadi and Dr. Najmeddin and Dr. Sadeghi and Dr. Kheirollah Gholami had the original idea and sent the proposal to Deputy of Research in the university. They also had established MTM Clinic which this research study has been conducted in it. Dr. Hadidi was the director of MTM Clinic at the time of this study and also supervised the conduction of the study. Dr. Fatemeh Gholami, under the supervision of Dr. Bita Shahrami, enrolled the patients in the study, Gathering and analyzing the data and drafting the primary manuscript. Dr. Shahrami also provided significant assistance in the initial and final writing and revision of the manuscript. Dr. Jamali has helped in revision of the final manuscript. Acknowledgments We appreciate participation of all patients in this study. Data Availability The raw material of the research project is attached as two excel forms. References Sayer I, Al-Azzam KH, Alzoubi S, AbuRuz Q, Alefan. Drug-related problems in a sample of outpatients with chronic diseases: a cross-sectional study from Jordan. 2016; 12: 233–2. Vm JF, Horvat N, Tommy W. Pharmaceutical Care Network Europe foundation. Cl Drug Relat Prob Rev. 2018;2(2):15–6. van den Bemt PM, Egberts TC, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf. 2000;22(4):321–33. Van den Bemt P. 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PCNE Classification for Drug-Related Problems V9.1. Published 2020. Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf . Accessed 11 Auguest 2025. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviewers invited by journal 27 Nov, 2025 Editor assigned by journal 26 Nov, 2025 Editor invited by journal 18 Nov, 2025 Submission checks completed at journal 16 Nov, 2025 First submitted to journal 16 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Bita","middleName":"","lastName":"Shahrami","suffix":""},{"id":552622170,"identity":"e5922876-049f-4f8e-a7c7-fbd6add3f660","order_by":2,"name":"Elham Hadidi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"","lastName":"Hadidi","suffix":""},{"id":552622171,"identity":"7e42c64d-333c-4078-939f-8e5ad4613f63","order_by":3,"name":"Farhad Najmeddin","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farhad","middleName":"","lastName":"Najmeddin","suffix":""},{"id":552622172,"identity":"0501d641-5ff1-4e01-b167-854e71f46ba1","order_by":4,"name":"Kourosh Sadeghi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kourosh","middleName":"","lastName":"Sadeghi","suffix":""},{"id":552622173,"identity":"8a20b21b-9c40-405b-9c5d-b128b9954b5c","order_by":5,"name":"Farzaneh Jamali","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farzaneh","middleName":"","lastName":"Jamali","suffix":""},{"id":552622174,"identity":"32392a45-bc65-4698-8a79-9bbad61c4efa","order_by":6,"name":"Mohammd Reza Javadi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammd","middleName":"Reza","lastName":"Javadi","suffix":""},{"id":552622176,"identity":"82abb283-33d6-4a1a-87fb-60953cdb0ff0","order_by":7,"name":"Kheirollah Gholami","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACCQkGNgaGAgYGNvYGmBhjA271cC0GQC08h0nVwiCRTKTDJGe3X3vwwcAumk/y/TGpG38Y5PkbmNs+4NMiLXOm3HCGQXJum3Qym3RuG4PhjAOMzTPwaZGTyEmT5jFghmppYGDcwMDYjNdhUC31uW2Sh9mkc/4w2BPUIi2Rfgyo5XBumwQzUAsbQyJBLZIzctgkZxgcz23jSTa2BmpMnnGYgBaJG+nPJD5UVOfObz/48HbOHxvb/vb2x3i1MDDwGKAYwcDATEADAwP7A4JKRsEoGAWjYIQDAO3dPit6sCsAAAAAAElFTkSuQmCC","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Kheirollah","middleName":"","lastName":"Gholami","suffix":""}],"badges":[],"createdAt":"2025-09-26 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16:16:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1091313,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7724048/v1/5f159913-9aee-4306-82e9-501ff6b8ad64.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Clinical Pharmacist Interventions on Drug-Related Problems in an Outpatient Pharmacotherapy Clinic: A Prospective Structured Follow-Up Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDrug-related problems (DRPs) are a major challenge in medication therapy, which, although intended to improve patient quality of life, can lead to adverse outcomes when not properly managed (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). DRPs are defined as events or circumstances involving drug therapy that interfere with desired health outcomes and can occur at any stage from prescribing to administration (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). They are categorized into two types: intrinsic toxicity, which relates to the drug\u0026rsquo;s own pharmacological properties and results in adverse drug reactions (ADRs), and extrinsic toxicity, which results from inappropriate drug use, leading to medication errors and DRPs (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Polypharmacy is another significant contributor to DRPs, making medication management even more complex (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMany DRPs, particularly those caused by medication errors, are preventable with timely and effective intervention (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Medication therapy management serves as a key strategy for providing clinical pharmacy services and preventing these problems. Clinical pharmacy has expanded from simple drug distribution to offering consultation and direct involvement in patient care, which helps optimize medication therapy and promotes better health outcomes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The establishment of outpatient clinics led by pharmacists represents a shift from traditional product-based pharmacy models to patient-centered care. These clinics focus on preventing and resolving medication therapy problems, ensuring more effective and safer treatment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the impact of clinical pharmacist interventions on the identification and resolution of DRPs in an outpatient pharmacotherapy clinic. Specifically, it assessed the prevalence and types of DRPs, the acceptance of pharmacist recommendations by patients and physicians, and the outcomes of these interventions over two structured follow-up visits. By focusing on a prospective outpatient setting, this study contributes to the evidence supporting the integration of pharmacist-led services to enhance medication safety and optimize patient care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eThis prospective interventional study was performed in duration of six months at the 13-Aban Pharmacotherapy Clinic affiliated with Tehran University of Medical Sciences (TUMS). This study was approved by the ethics committee of TUMS and Deputy of research with no fund provided. (IR.TUMS.PSRC.REC.1396.3379).\u003c/p\u003e\u003cp\u003eIndividuals aged 18 years and above with at least one chronic condition and a regimen of at least two long-term medications, whether prescribed or over-the-counter, were included in the study. Participants who failed to attend scheduled follow-up visits were excluded.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eEligible patients underwent a comprehensive review of their medical history at the time of admission into the study. For each patient, a medical record was created that included demographic data, laboratory results, and paraclinical findings. In the first visit, DRPs were identified by a thorough review of medication history.\u003c/p\u003e\u003cp\u003eAn individualized care plan was developed for each patient, including pharmacist recommendations and, when necessary, referral back to the physician for further evaluation or treatment modification. Two structured follow-ups were planned:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eA telephone follow-up at two weeks after the initial visit to assess the implementation of recommendations and detect any new or unresolved DRPs.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA final in-person follow-up at one month, which served as the study endpoint, to reassess the types, frequency, and evolution of DRPs.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThis one-month endpoint was selected to allow for a standardized and practical evaluation of short-term outcomes in the outpatient setting. Patients with unresolved or newly identified DRPs at the final visit were referred for further clinical care as appropriate.\u003c/p\u003e\n\u003ch3\u003eInterventions for managing DRPs\u003c/h3\u003e\n\u003cp\u003eTo handle the detected DRPs, the clinical pharmacist implemented as patient-related or physician-related interventions. These interventions were performed by a board-certified clinical pharmacotherapy specialist (known as clinical pharmacist) with the assistance of a PharmD student. For patient-related interventions, recommendations were provided verbally and in writing, recorded in the patient's file and their medication list. For physician-related interventions, referrals were made through written letters.\u003c/p\u003e\n\u003ch3\u003eStudy outcomes\u003c/h3\u003e\n\u003cp\u003eThe outcomes of this study were to identify the most common DRPs and their subtypes, as well as to assess the frequency of DRPs across different drug classes. Furthermore, the study aimed to explore the level of acceptance of interventions by both patients and physicians and the relationship between DRPs and possible risk factors such as the age and gender of patients. The primary outcome was the clinical benefit and resolution of DRPs through serial follow-up visits, which enabled dynamic monitoring and intervention adjustments.\u003c/p\u003e\n\u003ch3\u003eIdentification, classification, and analysis of DRPs\u003c/h3\u003e\n\u003cp\u003eReliable and up-to-date scientific resources, were used to identify DRPs. After identifying DRPs, they were categorized using the revised DOCUMENT system (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), which classifies DRPs into eight main categories, each further divided into various subcategories.\u003c/p\u003e\u003cp\u003eAnatomical Therapeutic Chemical (ATC) classification codes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) were used to define associations between causes in the therapeutic group and specific DPRs. These codes provide a standardized system for classifying drugs according to their anatomical structure, therapeutic effects, and chemical properties.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePatient adherence and physician acceptance\u003c/h2\u003e\u003cp\u003ePatient adherence was defined as the extent to which patients followed the recommended changes to their medication regimen, lifestyle, or monitoring plans as advised during the clinical pharmacist consultations.\u003c/p\u003e\u003cp\u003ePhysician acceptability referred to the physician's agreement with and implementation of the pharmacist's recommendations, including medication changes, referrals, or further diagnostic evaluations.\u003c/p\u003e\u003cp\u003eA score of 1 was given when the patient or physician accepted the recommendation or intervention, and a score of 0 when it was not accepted. The acceptance percentage of both patient-related and physician-related interventions was calculated based on the number of accepted interventions divided by the total number of interventions requiring follow-up.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe statistical analyses were carried out using the IBM SPSS Statistics software package, version 25.0 (IBM Corp, New York, USA). Nominal data were described as percentages and frequencies, and quantitative data were described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for normally distributed data, or as median and range for non-normally distributed data.\u003c/p\u003e\u003cp\u003eThe Kolmogorov-Smirnov test was used to assess the normality of the data. The student\u0026rsquo;s t-test and analysis of variance (ANOVA) were used to compare the means. The Pearson correlation and Kendall's tau-b tests were applied to define correlations for normal and non-normal distributions, respectively.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf all the patients referred to Pharmacotherapy clinic to review their DRPs, 57 met the inclusion criteria. The demographics and baseline characteristics are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1: Demographics and baseline characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eAge (mean \u0026plusmn; SD), total\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e61.67 \u0026plusmn; 11.30\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;62.5 \u0026plusmn; 11.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;60.5 \u0026plusmn; 10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMale/Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e34 (59.60%)/23 (40.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eNumber of diseases or conditions (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e6.68\u0026nbsp;\u0026plusmn; 2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eNumber of medications used (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e9.53\u0026nbsp;\u0026plusmn; 3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eNumber of medications associated with DRP (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e2.14\u0026nbsp;\u0026plusmn; 1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 623px;\"\u003e\n \u003cp\u003eData are presented as mean \u0026plusmn; standard deviation, or number of participants (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA total of 687 diseases were identified among the patients. The most frequently observed diseases in this study, in order of prevalence, were hypertension (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e96, 48%), diabetes mellitus (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e= 73, 36.5%), hyperlipidemia (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e60, 30%), and ischemic heart disease (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e45, 22.5%).\u003c/p\u003e\n\u003cp\u003eIn 18 (32%)\u0026nbsp;patients,\u0026nbsp;the majority of DRPs were identified during the first visit, with only a few more DRPs detected during the second and third visits. In 11 (19%) patients, the majority of DRPs were identified within two visits. However, 28 (49%) patients still had many DRPs detected by the third visit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence and characteristics of DRPs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 411 DRPs were identified during three distinct visits among the participants. The average frequency of DRPs in each visit is shown in Table 2. The most common types of DRPs\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ewere undertreated indications (32.6%), education and information (13.9%), monitoring (13.1%), and drug selection (12.9%). The most common subtypes of DRPs included the need for preventive treatment (18.2%), monitoring through laboratory tests (9.5%), and the presence of untreated symptoms and conditions (8.8%). The prevalence of various types and subtypes of DRPs is summarized in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 2: Average drug-related problems in each visit\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccasion of visit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage number of DRPs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eFirst visit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSecond visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eThird visit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e7.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003eDRPs: Drug-related problems\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Prevalence of various types and subtypes of DRPs\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eDRPs types and subtypes*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug selection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDuplication\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDrug interaction\u003c/p\u003e\n \u003cp\u003eWrong dosage form\u003c/p\u003e\n \u003cp\u003eWrong potency\u003c/p\u003e\n \u003cp\u003eContraindication\u003c/p\u003e\n \u003cp\u003eNo indication\u003c/p\u003e\n \u003cp\u003eAvailability of more effective drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (1.0)\u003c/p\u003e\n \u003cp\u003e9 (2.2)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003cp\u003e4 (1.0)\u003c/p\u003e\n \u003cp\u003e25 (6.1)\u003c/p\u003e\n \u003cp\u003e7 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOver or underdose prescribed\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDose too high\u003c/p\u003e\n \u003cp\u003eDose too low\u003c/p\u003e\n \u003cp\u003eIncorrect or unclear frequency, schedule, or duration\u003c/p\u003e\n \u003cp\u003eOther dose problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (2.7)\u003c/p\u003e\n \u003cp\u003e11 (2.7)\u003c/p\u003e\n \u003cp\u003e13 (3.2)\u003c/p\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompliance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTaking too little\u003c/p\u003e\n \u003cp\u003eTaking too much\u003c/p\u003e\n \u003cp\u003eIrregular drug intake\u003c/p\u003e\n \u003cp\u003eDifficulty using dosage form\u003c/p\u003e\n \u003cp\u003eConcern about side effects\u003c/p\u003e\n \u003cp\u003eLack of understanding of proper use\u003c/p\u003e\n \u003cp\u003eUnwillingness to take medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (1.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e10 (2.4)\u003c/p\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003cp\u003e9 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUndertreated indications\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCondition not adequately treated\u003c/p\u003e\n \u003cp\u003eCondition indicating undertreated\u003c/p\u003e\n \u003cp\u003ePreventive therapy required\u003c/p\u003e\n \u003cp\u003eOther untreated indication problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (4.9)\u003c/p\u003e\n \u003cp\u003e36 (8.8)\u003c/p\u003e\n \u003cp\u003e75 (18.2)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonitoring\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLaboratory monitoring\u003c/p\u003e\n \u003cp\u003eNon-laboratory monitoring\u003c/p\u003e\n \u003cp\u003eOther monitoring problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (9.5)\u003c/p\u003e\n \u003cp\u003e12 (2.9)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation or information\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePatient drug information request\u003c/p\u003e\n \u003cp\u003eDisease management or advice\u003c/p\u003e\n \u003cp\u003eConfusion about therapy\u003c/p\u003e\n \u003cp\u003eDemonstration of device\u003c/p\u003e\n \u003cp\u003eOther education or information problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17(4.1)\u003c/p\u003e\n \u003cp\u003e22 (5.4)\u003c/p\u003e\n \u003cp\u003e9 (2.2)\u003c/p\u003e\n \u003cp\u003e8 91.9)\u003c/p\u003e\n \u003cp\u003e1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-clinical\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDrug unavailability\u003c/p\u003e\n \u003cp\u003eHigh drug cost relative to patient income\u003c/p\u003e\n \u003cp\u003eDifficulty obtaining a specific drug brand\u003c/p\u003e\n \u003cp\u003eLack of access to drugs in the patient\u0026rsquo;s location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (1.9)\u003c/p\u003e\n \u003cp\u003e7 (1.7)\u003c/p\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToxicity or adverse drug reaction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eProblem caused by drug interaction\u003c/p\u003e\n \u003cp\u003eApparent toxicity with a suspected drug-related cause\u003c/p\u003e\n \u003cp\u003eToxicity evident\u003c/p\u003e\n \u003cp\u003eDrug-drug interaction\u003c/p\u003e\n \u003cp\u003eOther toxicity problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (1.7)\u003c/p\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003cp\u003e13 (3.2)\u003c/p\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003cp\u003e6 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eDRPs: Drug related problems\u003c/p\u003e\n \u003cp\u003e*According to DOCUMENT system\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of the revised ATC codes for drugs causing DRPs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDistribution of the revised ATC codes for drugs causing DRPs is shown in Table 4. Since some DRPs were not associated with a specific drug, another category called \u0026quot;unrelated to a specific drug\u0026quot; was added to the ATC codes. This category included the highest number of DRPs (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e133), and the most frequently reported DRPs in this category were related to monitoring (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e51). Besides this category, the most common DRPs associated with specific diseases were as follows: alimentary tract and metabolism (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e82), anti-infectives for systemic use (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e66), and cardiovascular system (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e60). In the first two categories, the principal causes of DRPs were undertreated indications (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e33 and N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e52, respectively), and in the third category, the leading cause was over or under dosage (N = 23).\u003c/p\u003e\n\u003cp\u003eTable 4: Distribution of the revised-ATC codes in DRPs\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDRPs*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"16\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRevised-ATC codes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD\u003c/strong\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eG\u003c/strong\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJ\u003c/strong\u003e\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eL\u003c/strong\u003e\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eV\u003c/strong\u003e\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e134\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e411\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eATC:\u003c/strong\u003e Anatomical therapeutic chemical\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDRPs:\u003c/strong\u003e Drug related problems\u003c/p\u003e\n \u003cp\u003e*According to DOCUMENT system\u003c/p\u003e\n \u003cp\u003e[1]\u0026nbsp;Alimentary tract and metabolism\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;Blood and blood-forming organs\u003c/p\u003e\n \u003cp\u003e3\u0026nbsp;Cardiovascular system\u003c/p\u003e\n \u003cp\u003e4\u0026nbsp;Dermatologicals\u003c/p\u003e\n \u003cp\u003e5\u0026nbsp;Genitourinary system and sex hormones\u003c/p\u003e\n \u003cp\u003e6\u0026nbsp;Systemic hormonal preparations, excl. sex hormones and insulins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7\u0026nbsp;Anti-infectives for systemic use\u003c/p\u003e\n \u003cp\u003e8\u0026nbsp;Antineoplastic and immunomodulating agents\u003c/p\u003e\n \u003cp\u003e9\u0026nbsp;Musculoskeletal system\u003c/p\u003e\n \u003cp\u003e10\u0026nbsp;Nervous system\u003c/p\u003e\n \u003cp\u003e11\u0026nbsp;Antiparasitic products, insecticides and repellents\u003c/p\u003e\n \u003cp\u003e12\u0026nbsp;Respiratory system\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e13\u003c/sup\u003e Sensory organs\u003c/p\u003e\n \u003cp\u003e14\u0026nbsp;Unrelated to a specific drug\u003c/p\u003e\n \u003cp\u003e15\u0026nbsp;Various\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with DRPs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe correlation between DRPs and variables such as age (P = 0.963), number of comorbidities (P = 0.283), total number of medications (P = 0.499), and adherence to treatment regimens (P = 0.523) were not significant. However, a significant correlation was found regarding gender. The prevalence of DRPs was higher in males, averaging 5.1 compared to 3.3 in females (P = 0.002).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical pharmacist interventions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAltogether, 411 interventions were carried out for each identified DRP across the three visits. Among these, 102 (24.8%) interventions were related to referral letters written to physicians, and 309 (75.1%) interventions were related to oral and written advice and education given to patients. These interventions were done according to intervention protocol listed by the clinic and their distribution in DRPs (Table 5). The most common interventions were referral to physicians (N = 102), over-the-counter (OTC) medication prescribing (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e76), and education (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e70). The most frequent DRPs associated with these interventions were undertreated conditions for \u0026ldquo;referrals to physicians\u0026rdquo; and \u0026ldquo;OTC medication prescribing\u0026rdquo; categories (N\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e=\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e54 and 65, respectively), and education or information (N = 33) for \u0026ldquo;education\u0026rdquo; category.\u003c/p\u003e\n\u003cp\u003eTable 5: DRPs distribution in clinic\u0026rsquo;s intervention protocol\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eInterventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eDRPs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eReferral to MD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePrescribing OTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eEducation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eLaboratory test prescription\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eCounselling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eDosing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eIndication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eAdministration\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eAvailability\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eInteraction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSide effect\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTherapeutic substitution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eProduct identification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 585px;\"\u003e\n \u003cp\u003eDRPs: Drug-related problems\u003c/p\u003e\n \u003cp\u003eMD:\u003csup\u003e\u0026nbsp;\u003c/sup\u003eDoctor of Medicine\u003c/p\u003e\n \u003cp\u003eOTC: Over-the-counter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePatient adherence and physician acceptance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe acceptance rate for patient-related interventions was 68.3%. In the first follow-up, 170 out of 249 (68.2%) interventions and in the second follow-up, 33 out of 48 (68.75%) interventions were accepted by patients. The highest acceptance rate among DRP categories was for education or information interventions (85.7%), while the lowest acceptance rate was for undertreated interventions (58.8%).\u003c/p\u003e\n\u003cp\u003eDuring the two follow-ups, a total of 73 referral interventions to physicians were documented. Of these, patients presented 50 referral letters to physicians, and 25 of these were accepted, leading to an acceptance rate of 50% among the physicians. Table 6\u0026nbsp;provides\u0026nbsp;details\u0026nbsp;concerning\u0026nbsp;the acceptance rates\u0026nbsp;of both\u0026nbsp;patients and physicians.\u003c/p\u003e\n\u003cp\u003eTable 6: Acceptance rates of patients and physicians\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up visit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of interventions performed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysician-dependent interventions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient-dependent interventions\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst (by phone)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 131px;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e64 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eInterventions delivered to physician:\u003c/p\u003e\n \u003cp\u003e46 (71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e185 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eInterventions accepted by patient:\u003c/p\u003e\n \u003cp\u003e124 (67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eInterventions accepted by physician:\u003c/p\u003e\n \u003cp\u003e23 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond (in-person)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 131px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e9 (18.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eInterventions delivered to physician:\u003c/p\u003e\n \u003cp\u003e4 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e39 (81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eInterventions accepted by patient:\u003c/p\u003e\n \u003cp\u003e29 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eInterventions accepted by physician:\u003c/p\u003e\n \u003cp\u003e2 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated the important role of pharmacist intervention in addressing DRPs in outpatient care and highlighted its importance in improving patient outcomes and medication safety. The results showed an average of 4.37 DRPs per patient during the initial visit, which is comparable to that reported in other studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, this average was higher than the average DRPs reported by Xin Wang et al. and Haugb\u0026oslash;lle et.al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This difference might be due to the fact that patients in this study were taking a higher number of medications, or it could be that only patients experiencing DRPs sought care at our clinic.\u003c/p\u003e\u003cp\u003eIn this study, the most frequently identified DRPs were undertreated indications, education or information, and drug selection. In studies that classified the DRPs in a similar way to ours, drug selection, toxicity or ADR, undertreated indications, and non-compliance were reported as frequently detected DRPs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, the most common subtypes of DRPs identified in this study were preventative therapy required, laboratory monitoring, and undertreated conditions. In other studies, patient requests for drug information and untreated conditions were the most common subtypes (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Based on these findings, it can be assumed that patients often lack adequate awareness of their medical conditions and medications. Many patients do not receive the essential information they need about their medications, which can hinder pharmacotherapy outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe most commonly associated drugs with DRPs, based on their ATC codes, included those related to the alimentary tract and metabolism, anti-infectives for systemic use, and cardiovascular system. In a similar study, the most common categories were alimentary tract and metabolism, cardiovascular system, and nervous system (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, other findings indicated that the cardiovascular system was the most frequently reported category, as with other studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These results highlight the necessity for identifying high-risk drugs, and the importance of educating and counseling patients. They also suggest the establishment of specialized centers to identify and manage DRPs.\u003c/p\u003e\u003cp\u003eRegarding the risk factors related to the prevalence of DRPs, the only factor found to be associated with DRPs was gender, with a higher prevalence in men compared to women. In another study conducted in our clinic, DRPs also showed associations with gender (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In contrast, other studies have shown an opposite pattern (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Also, a study conducted by Garin N et al. pointed out that factors such as polypharmacy were associated with the prevalence of DRPs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The significant association with the male gender observed in our study could be due to the social structure of clients coming to this pharmacotherapy clinic, with a higher percentage of male clients.\u003c/p\u003e\u003cp\u003eAfter conducting two follow-ups in this study, a significant number of patients still had unresolved DRPs, indicating that more than two follow-ups were necessary to fully identify and resolve all DRPs in patients. Another study conducted by Wung JC et al. also showed that a large number of DRPs remain unresolved even after a long-term follow-up (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Interestingly, although the number of DRPs decreased after the first intervention (from visit 1 to 2), a moderate increase was observed during the third visit. This rise is likely due to the emergence of new clinical issues, disease progression, or patients not fully adhering to previous recommendations. These findings highlight the dynamic and evolving nature of DRPs in outpatient care and underscore the importance of continued pharmacist involvement over time.\u003c/p\u003e\u003cp\u003eThis study demonstrated that most of the interventions were accepted by the patients. The main issue patients face appears to be a lack of knowledge about their medications and medical conditions. Therefore, many DRPs could be prevented if healthcare teams provided thorough explanations about medications and patients' conditions before starting treatment, ensuring that patients fully understood the recommendations given to them.\u003c/p\u003e\u003cp\u003eAdditionally, the level of acceptance among physicians regarding the recommendations in this study was significantly lower than that reported in similar studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This discrepancy could be attributed to the fact that recommendations in this study were mainly delivered in a written form, whereas another study suggested that indirect communication with physicians might decrease the acceptance of such recommendations (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In other comparable studies conducted in hospital settings, pharmacists often had face-to-face interactions with physicians, which yielded a better acceptance rate (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study had several limitations that should be acknowledged. First, although the study design included two structured follow-ups to assess the outcomes of pharmacist interventions, it became evident that two follow-ups may not be sufficient to identify and resolve all drug-related problems (DRPs), especially those that emerge later due to disease progression, new prescriptions, or incomplete adherence. A longer follow-up period with additional visits could have provided a more comprehensive evaluation of DRP resolution and sustained clinical benefits. Second, the sample size was relatively limited, and participants were recruited from a single outpatient pharmacotherapy clinic affiliated with a university hospital. This may reduce the generalizability of the findings to broader outpatient populations, especially in rural or non-academic settings. Third, loss to follow-up was a potential source of bias, as patients who did not complete both follow-up visits were excluded from the final analysis. This may have introduced selection bias if those lost to follow-up had different DRP profiles or outcomes than those who remained. Fourth, the classification of DRPs was based on the revised DOCUMENT system, which, although widely used in some studies, may not be as comprehensive or standardized for international comparisons as newer systems like the Pharmaceutical Care Network Europe (PCNE) classification. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) Future studies could benefit from using more universally adopted frameworks to improve comparability and precision. Lastly, the intervention delivery method particularly the written communication to physicians may have limited the acceptance of pharmacist recommendations. In-person or real-time collaborative discussions might have enhanced interdisciplinary engagement and increased the implementation rate of clinical suggestions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDRPs are prevalent among patients with chronic conditions and require specialized, continuous care for effective management. This study highlights the critical role of clinical pharmacist-led follow-up visits, which not only facilitate early detection and resolution of DRPs but also support sustained improvements in medication safety. The structured follow-up process including individualized education, counseling, and timely interventions resulted in high acceptance rates and a notable reduction in DRPs over time. Effective history-taking, clear communication, and appropriate use of OTC treatments and specialist referrals further enhanced outcomes. These findings support the integration of clinical pharmacist-led follow-ups into routine outpatient care to promote safer and more effective pharmacotherapy, even within short-term intervention frameworks.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDRPs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003edrug-related problems\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eADRs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eadverse drug reactions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOTC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eover-the-counter\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCNE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epharmaceutical care network Europe\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eInformed consent\u003c/h2\u003e\u003cp\u003ewas obtained from all participants. The form is attached as a PDF. The ethics approval certificate is also attached as a PDF. This study was approved by the ethics committee of TUMS and Deputy of research with no fund provided. (IR.TUMS.PSRC.REC.1396.3379)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e Consent is granted for the publication of this article.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eWe declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe contribution of the authors for this manuscript is as follows: Dr. Javadi and Dr. Najmeddin and Dr. Sadeghi and Dr. Kheirollah Gholami had the original idea and sent the proposal to Deputy of Research in the university. They also had established MTM Clinic which this research study has been conducted in it. Dr. Hadidi was the director of MTM Clinic at the time of this study and also supervised the conduction of the study. Dr. Fatemeh Gholami, under the supervision of Dr. Bita Shahrami, enrolled the patients in the study, Gathering and analyzing the data and drafting the primary manuscript. Dr. Shahrami also provided significant assistance in the initial and final writing and revision of the manuscript. Dr. Jamali has helped in revision of the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003eWe appreciate participation of all patients in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw material of the research project is attached as two excel forms.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSayer I, Al-Azzam KH, Alzoubi S, AbuRuz Q, Alefan. Drug-related problems in a sample of outpatients with chronic diseases: a cross-sectional study from Jordan. 2016; 12: 233\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVm JF, Horvat N, Tommy W. Pharmaceutical Care Network Europe foundation. Cl Drug Relat Prob Rev. 2018;2(2):15\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan den Bemt PM, Egberts TC, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf. 2000;22(4):321\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan den Bemt P. Drug related problems: definitions and classification. EJHP Pract. 2005;11:16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaufmann CP, St\u0026auml;mpfli D, Hersberger KE, Lampert ML. Determination of risk factors for drug-related problems: a multidisciplinary triangulation process. 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Accessed october 24, 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams M, Peterson GM, Tenni PC, Bindoff IK, Stafford AC. DOCUMENT: a system for classifying drug-related problems in community pharmacy. Int J Clin Pharm. 2012;34(1):43\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO Collaborating Center for Drug Statistics Methodology. The anatomical therapeutic chemical (ATC) classification system. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.whocc.no/atc_ddd_index/\u003c/span\u003e\u003cspan address=\"http://www.whocc.no/atc_ddd_index/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed March 2, 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStafford AC, Tenni PC, Peterson GM, Jackson SL, Hejlesen A, Villesen C, et al. Drug-related problems identified in medication reviews by Australian pharmacists. Pharm World Sci. 2009;31(2):216\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaugb\u0026oslash;lle LS, S\u0026oslash;rensen EW. Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma\u0026ndash;interviewing patients at home. Pharm World Sci. 2006;28(4):239\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShahrami B, Sefidani Forough A, Najmeddin F, et al. Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic. J Clin Pharm Ther. 2022;47:964\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Wang S, Yu X, et al. Impact of pharmacist-led medication therapy management in ambulatory elderly patients with chronic diseases. Br J Clin Pharmacol. 2021;87:2937\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBekker CL, Mohsenian Naghani S, Natsch S, Wartenberg NS, van den Bemt BJF. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study. Int J Clin Pharm. 2020;42(6):1396\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11096-020-01125-x\u003c/span\u003e\u003cspan address=\"10.1007/s11096-020-01125-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Aug 28. PMID: 32857256; PMCID: PMC7603457.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePl\u0026aacute;cido AI, Herdeiro MT, Morgado M, Figueiras A, Roque F. Drug-related Problems in Home-dwelling Older Adults: A Systematic Review. Clin Ther. 2020;42(4):559\u0026ndash;e57214. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clinthera.2020.02.005\u003c/span\u003e\u003cspan address=\"10.1016/j.clinthera.2020.02.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Mar 5. PMID: 32147147.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoughead EE, Barratt J, Gilbert AL. Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf. 2004;13(2):83\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarin N, Sole N, Lucas B, Matas L, Moras D, Rodrigo-Troyano A, Gras-Martin L, Fonts N. Drug related problems in clinical practice: a cross-sectional study on their prevalence, risk factors and associated pharmaceutical interventions. Sci Rep. 2021;11(1):883. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-020-80560-2\u003c/span\u003e\u003cspan address=\"10.1038/s41598-020-80560-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33441854; PMCID: PMC7807048.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWung JC, Lin HC, Hsu CC, Lin CC, Wang SY, Chang SL, Chang YL. Drug-related problem characterization and the solved status associated factor analysis in a pharmacist-managed anticoagulation clinic. PLoS ONE. 2022;17(8):e0270263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0270263\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0270263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35969589; PMCID: PMC9377620.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZaal R. Drug-Related Problems [Internet]. 2016. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://hdl.handle.net/1765/94517\u003c/span\u003e\u003cspan address=\"http://hdl.handle.net/1765/94517\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 11 Aug 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKjeldsen LJ, Birkholm T, Fischer H, Graab\u0026aelig;k T, Kibsdal KP, RavnNielsen LV, et al. Characterization of drug-related problems identified by clinical pharmacy staff at Danish hospitals. Int J Clin Pharm. 2014;36(4):734\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNielsen TRH, Andersen SE, Rasmussen M, Honor\u0026eacute; PH. Clinical pharmacist service in the acute ward. Int J Clin Pharm. 2013;35(6):1137\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMogensen CB, Olsen I, Thisted AR. Pharmacist advice is accepted more for medical than for surgical patients in an emergency department. Dan Med J. 2013;60(8):A4682\u0026ndash;A.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePharmaceutical Care Network Europe (PCNE). PCNE Classification for Drug-Related Problems V9.1. Published 2020. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf\u003c/span\u003e\u003cspan address=\"https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 11 Auguest 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Drug-Related Problem (DRP), Medication Therapy Management (MTM), Pharmacotherapy, Out-Patient Service, Pharmacist’s Intervention","lastPublishedDoi":"10.21203/rs.3.rs-7724048/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7724048/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDrug-related problems (DRPs) are prevalent in outpatient settings and may result in adverse drug reactions and medication errors. Pharmacists are crucial in identifying and resolving DRPs, particularly for patients with chronic conditions and those on multiple medications. This study assessed the impact of pharmacist interventions on identification and resolution of DRPs, focusing on their prevalence, effectiveness, and acceptance by patients and physicians.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis prospective interventional study included adult patients with at least one chronic condition and two or more long-term medications. DRPs were identified through comprehensive medication reviews and categorized using the DOCUMENT classification system. Interventions were provided by clinical pharmacists, and outcomes were assessed at two structured follow-ups: a telephone follow-up at two weeks and an in-person visit at four weeks.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 411 DRPs were identified, with undertreated indications (32.6%), education/information gaps (13.9%), and monitoring issues (13.1%) being the most common ones. The prevalence of DRPs was higher in males than females (5.1 vs. 3.3, P\u0026thinsp;=\u0026thinsp;0.002). Pharmacists implemented 411 interventions, with 75.1% directed at patients and 24.8% involving referrals to physicians. The overall acceptance rate was 68.3% for patient-related interventions and 50% for physician-related interventions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePharmacist-led interventions in outpatient care significantly contributed to the identification and partial resolution of DRPs. Structured follow-up visits and patient education improved medication safety and highlighted the value of integrating clinical pharmacists into routine outpatient care..\u003c/p\u003e","manuscriptTitle":"Evaluation of Clinical Pharmacist Interventions on Drug-Related Problems in an Outpatient Pharmacotherapy Clinic: A Prospective Structured Follow-Up Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 15:04:20","doi":"10.21203/rs.3.rs-7724048/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-22T09:15:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308682087170204956032285645382062373049","date":"2025-12-17T08:29:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278975668043458729152936724511267906668","date":"2025-11-29T10:35:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-27T05:00:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-27T04:56:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-18T14:04:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-16T21:21:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-11-16T21:18:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb945c7c-7339-4f00-9695-8c8927cd1127","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T15:04:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 15:04:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7724048","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7724048","identity":"rs-7724048","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}