[Integral computerization of health care for inpatients. Impact on primary care activities]

Due to its iatrogenic potential and economic impact, drug prescription is one of the most complex tasks within the health care process. Electronic prescription systems (EPS), and particularly expert systems, increase quality by reducing errors in the prescribing and dispensing processes. Besides, electronic prescription reduces costs. On the other hand, it demands a new equilibrium in the delivery of pharmaceutical services.

The EPS established at "Hospital de la Ribera" is described. This system is basically characterised by: (1) its integration within the electronic global system throughout a computer network; (2) drugs are ordered directly by physicians in the electronic system; (3) pharmacists access the whole clinical record of patients "in situ"; (4) and integration of clinical activities by pharmacists in the patient medical record. The impact of this system on pharmaceutical care activities such as identification, reporting and documentation of drug-related problems (DRPs) versus traditional approaches is analysed.

Access to patient information throughout the system facilitates DRP identification, with a resulting overall prevalence of clinically relevant drug-related problems of 9%.

The model implemented in our hospital favours the development of clinical activities by pharmacists as it allows communication among health care professionals, activities are permanently recorded in patient medical charts, and a formal document of pharmacist involvement and compromise with the clinical progress and outcome of patients ensues.