Background
Preventable drug-related morbidity (PDRM) is likely to be a leading cause of hospital admission in industrialized countries. A set of indicators for PDRM from the UK and the US have been validated for primary care in Portugal. The use of PDRM indicators at a patient level could help to improve the safety and the quality of health-care. Studies were set to explore both practice pharmacists' and leaders' perceptions on its potential applicability in community practice. This paper focuses on leaders' views on the use of the PDRM indicators in Portuguese community pharmacy.

Method
An invitation for an in-depth interview was sent to purposively selected leaders within Governmental and professional organizations/initiatives in health care. These included the presidents of the Pharmaceutical Society, the Health Directorate General, the Institute for Quality in Healthcare, the Portuguese Association of General Practitioners, the Regulatory Drug Agency and the Good Pharmacy Practice (GPP) programme. In addition, the vice-president of the National Association of Pharmacies (ANF), a Parliament member (community pharmacist) and the head of the pharmaceutical care department (ANF) were invited. Individuals that agreed to participate were sent brief information on the research programme, the interview guide and a consent form. Interviews were audio-taped and transcribed verbatim. Transcripts were coded (NVIVO v. 2.0) and analyzed using a framework approach.

Results
All individuals approached (six pharmacists, two physicians) agreed to participate. Interviews took place between April and November 2004. All interviewees agreed in principle with the applicability of PDRM indicators in community pharmacy, while acknowledging that differences exist between the four categories of indicators. Failure to prescribe and monitoring indicators, mainly concerned with lack of treatment with a needed drug and laboratory monitoring, were deemed more difficult to use than prescribing and dispensing indicators, which deal with issues such as drug interactions and counseling, respectively. Leaders agreed overall with the top facilitators identified by practice pharmacists for the application of PDRM indicators (training, good relationship with patients and partnership with physicians), but other factors emerged, including the aid of computerization and Governmental and professional organizations' support. Inter-professional issues identified by pharmacists were strongly echoed by most leaders, who raised other obstacles to the use of the indicators, including lack of shared electronic patient records and insufficient clinical training of community pharmacists.

Discussion
There were no clear differences between the views of medical and pharmacy leaders regarding the potential applicability of PDRM indicators. Facilitators and barriers to the use of PDRM indicators in community practice identified by leaders are not unexpected1. Further insight into these issues will be gained with a feasibility study, currently underway, using 28 PDRM indicators in a purposive sample of 16 Portuguese community pharmacies.