Development and evaluation of the pharmacist intervention evaluation (PIE) system: a modified classification for...

Identification and intervention of drug-related problems (DRPs) is a cornerstone for pharmaceutical care. An effective classification system of DRPs enables to identify the origin of DRPs and improve performance management of pharmacists. However, a standardized DRPs classification system tailored to the Chinese healthcare environment has not been established.

To establish and validate Pharmacist Intervention Evaluation (PIE) System, which is a modified Pharmaceutical Care Network Europe (PCNE) DRPs classification system, and further compared the efficacy, acceptability, and feasibility with PCNE system in tertiary hospitals in China.

This study used a multi-phase methodological design comprising (1) development and content refinement of the PIE classification through structured expert consensus and pilot testing, and (2) a prospective, multi-center field evaluation using consecutively captured DRP reports from routine clinical pharmacy practice. A total of 1398 DRP reports were identified, intervened, and recorded by clinical pharmacists according to PCNE and PIE systems, respectively. The classification efficacy, acceptability, and feasibility of the two systems were compared. Multivariate regression analysis was employed to identify factors associated with classification efficacy of PIE system.

PIE system, consisting of 6 primary and 27 secondary categories, was constructed and validated through expert consensus and multi-center prospective studies. PIE system achieved a significantly higher classification efficacy than PCNE system (92.06% vs. 73.10%, p < 0.001). Regarding acceptability and feasibility, PIE system showed comparable performance to PCNE system (mean Likert score: 4.2 ± 0.83 vs. 3.7 ± 1.07, p = 0.113), with no statistically significant differences in coverage, clarity, and ease of use. Multivariate regression analyses identified physician decision-making errors (OR = 3.756, p < 0.001) and prescription/dispensing errors (OR = 3.139, p = 0.001) as two vital factors associated with successful DRPs classification in PIE system. Among classified DRPs, 77.24% were mild clinical impact (Level 1), 96.04% were related to prescription issues, and 95.80% of pharmacist interventions were accepted.

PIE system, a modified DRPs classification system adapted to Chinese healthcare settings, was successfully established and validated. PIE system provides a valuable tool for DRPs management, source tracing, and pharmacist performance evaluation in China.