Background Denmark’s first Multidisciplinary Clinic for non-specific cancer symptoms opened at Silkeborg Regional Hospital in 2009. In 2013 a clinical pharmacist was integrated into the clinic to carry out full medicines reviews on patients. One success criterion was that 70% of the recommendations made by the pharmacist should be clinically relevant. Assessment of clinical relevance is often subjective. To determine the clinical relevance a certain level of consensus was required and therefore a modified Delphi method was employed. Purpose To describe the use of a modified Delphi method to reach consensus in an expert panel evaluating the clinical relevance of pharmacist’s recommendations. Materials and methods An expert panel of 9 healthcare professionals (3 hospital physicians, 3 general practitioners, 2 clinical pharmacists, 1 pharmacologist) received 23 randomised pharmacist recommendations. The experts scored the recommendations using the six categories described in Hatoun’s ranking system. Category 3 to 6 was classified as having clinical relevance. The experts sent their scoring with arguments to the facilitator, who provided an anonymous summary of the experts’ scoring and arguments for the second round, so that the cases where no consensus was previously achieved could be revised by the experts. In cases of no consensus after 2 rounds the project group evaluated the scores. Results From the set there was consensus in 48% of recommendations after the first round. After the second round, consensus increased to 87%. The overall results showed that 87% of the recommendations were clinically relevant. The members of the expert panel themselves, expressed professional interest in arguments presented by the other members of the group. They also found it convenient that they could participate without having to meet. Conclusions The modified Delphi method enabled a group of experts from different professions to evaluate the recommendations, reaching a high level of consensus. No conflict of interest.

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Background Denmark’s first outpatient clinic for multimorbidity and polypharmacy opened at Silkeborg Regional Hospital in 2012. The clinic treats patients with at least 2 chronic illnesses, who present with a variety of symptoms. The pharmacist is an integral member of the multidisciplinary team that sees the patient during a single visit. The team includes a nurse, medical consultant, physio- and occupational therapist, and relevant senior doctors from 9 other medical specialities, including psychiatry. Purpose To document the impact of a pharmacist on identification of potential side effects to regular medicines and on other medicines-related problems (MRP) in patients at a clinic for patients with multimorbidity. Materials and methods Before the patient sees the consultant, the pharmacist interviews the patient about all aspects of his medicines history (including over the counter medicines and herbal/natural medicines) and updates the electronic prescribing system. A full medicines review is then carried out with extra focus on possible side effects. The pharmacist presents relevant MRP to the doctor before the patient’s consultation. The pharmacist is also present at the following multidisciplinary conference about the patient. MRP found are recorded in a national database (LRP database). Results The pharmacist saw 58 patients from May 2012 to September 2013 and highlighted 208 MRP. The patients at the clinic have on average 12.3 (3–26) regular medicines. Twenty-nine patients had potential side effects to their regular medicines (from 1–11). Ninety-four (45%) of the pharmacist’s 208 suggestions were implemented at the clinic, where 20 were related to the 70 highlighted possible side effects. Conclusions With special focus on side effects to regular medicines, the pharmacist highlighted potential side effects in 50% of the patients at the clinic for multimorbidity and polypharmacy. Despite the clinic being an outpatient clinic, the acceptance rate for the pharmacist’s suggestions was surprisingly high. No conflict of interest.