What is the Classification of Pharmaco-Therapeutic Referrals?


The Classification of Pharmaco-Therapeutic Referrals (CPR) is a taxonomy focused on defining and grouping together situations requiring a referral from pharmacists to physicians (and vice versa) regarding the pharmacotherapy used by the patients. It has been published in 2008. It is bilingual: English/Spanish (Clasificación de Derivaciones Fármaco-terapéuticas).

It is a simple and efficient classification of pharmaco-therapeutic referrals between physicians and pharmacists permitting a common inter-professional language. It is adapted to any type of referrals among health professionals, and to increase its specificity it can be combined with ATC codes, ICD-10, and ICPC-2 PLUS.

It is a part of the MEDAFAR Project, whose objective is to improve, through different scientific activities, the coordination processes between physicians and pharmacists working in primary health care.

Supporting Institutions

  • Pharmaceutical Care Foundation of Spain (Fundación Pharmaceutical Care España).
  • Spanish Society of Primary Care Doctors (Sociedad Española de Médicos de Atención Primaria) (SEMERGEN).


  • Raimundo Pastor Sánchez (Family practice, “Miguel de Cervantes” Primary Health Centre SERMAS Alcalá de Henares – Madrid – Spain).
  • Carmen Alberola Gómez-Escolar (Pharmacist, Vice-President Fundación Pharmaceutical Care España).
  • Flor Álvarez de Toledo Saavedra (Community pharmacist, Past-President Fundación Pharmaceutical Care España).
  • Nuria Fernández de Cano Martín (Family practice, “Daroca” Primary Health Centre SERMAS Madrid – Spain).
  • Nancy Solá Uthurry (Doctor in Pharmacy, Fundación Pharmaceutical Care España).


It is structured in 4 chapters (E, I, N, S) and 38 rubrics. The terminology used follows the rules of ICPC-2.

Each rubric consists in an alphanumeric code (the letter corresponds to the chapters and the number to the component) and each title of the rubric (the assigned name) is expressed and explained by:

  • A series of terms related with the title of the rubric.
  • A definition expressing the meaning of the rubric.
  • A list of inclusion criteria and another list with exclusion criteria to select and qualify the contents corresponding to a rubric.
  • Some example to illustrate every term.

It also includes a glossary of 51 terms defined by consensus, an alphabetical index with 350 words used in the rubrics; and a standardised model of inter-professional referral form, to facilitate referrals from community pharmacists to primary care physicians.

Classification of Pharmaco-Therapeutic Referrals MEDAFAR

E. Effectiveness/Efficiency

  • E 0. Effectiveness / Efficiency, unspecified.
  • E 1. Indication.
  • E 2. Prescription and dispensing conditions.
  • E 3. Active substance / excipient.
  • E 4. Pharmaceutical form / how supplied.
  • E 5. Dosage.
  • E 6. Quality.
  • E 7. Storage.
  • E 8. Consumption.
  • E 9. Outcome.

I. Information/Health Education

  • I 0. Information / health education, unspecified.
  • I 1. Situation / reason for encounter.
  • I 2. Health problem.
  • I 3. Complementary examination.
  • I 4. Risk.
  • I 5. Pharmacological treatment.
  • I 6. No pharmacological treatment.
  • I 7. Treatment goal.
  • I 8. Socio-healthcare system.

N. Need

  • N 0. Need, unspecified.
  • N 1. Treatment based on symptoms and/or signs.
  • N 2. Treatment based on socio-economic-work issues.
  • N 3. Treatment based on public health issues.
  • N 4. Prevention.
  • N 5. Healthcare provision.
  • N 6. Complementary test for treatment control.
  • N 7. Administrative activity.
  • N 8. On patient request (fears, doubts, wants).

S. Safety

  • S 0. Safety, unspecified.
  • S 1. Toxicity.
  • S 2. Interaction.
  • S 3. Allergy.
  • S 4. Addiction (dependence).
  • S 5. Other side effects.
  • S 6. Contraindication.
  • S 7. Medicalisation.
  • S 8. Non-regulate substance.
  • S 9. Data / confidentiality.

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