Detection of drug related problems in an interdisciplinary health care model for rural areas in Germany
- 447 Downloads
Objective The disparity between an increasing complexity of patients’ treatment and the declining number of general practitioners (GP) require action. The AGnES-concept (general practitioner-relieving, community-based, e-health assisted, systemic intervention) is based on the delegation of original physician-activities to qualified AGnES-practice assistants. Purposes of AGnES part 1 were to determine the feasibility of community-based home medication reviews (HMR) and the establishment of a health professional network to identify drug related problems (DRP) in the domicile of elderly patients. Two consecutive studies (AGNES 2 + 3) were conducted to implement HMR. Setting General practices on the isle of Rugia in Mecklenburg-Western Pomerania, a German rural area. Patients who receive regular home visits by their GP were addressed. Method Study-instruments for the feasibility study (AGnES 1) were designed by an expert panel and modified for the implementation (AGnES 2 + 3) studies. HMR were conducted by additionally qualified AGnES-practice assistants regarding DRP like drug–drug interaction (DDI), adverse drug reactions (ADR), and compliance. DRP-selection was inspired by the coding system Pi-Doc. Pharmacists checked DRP and intervened, if necessary. 18 (AGnES 1) and 60 (AGnES 2 + 3) geriatric patients received a minimum of two home visits by an AGnES-practice assistant. Main outcome measure Feasibility was assessed by patients’ satisfaction with care provided by the AGnES-practice assistant. For implementation reported DRP and the conducted interventions were evaluated. Results During AGnES 1 a documentation sheet was developed and tested. 56 potential DDI were identified. 37 of 112 drugs which caused potential interactions were attributed to OTC medication and food components. 84% of respondents judged the systematic evaluation of their pharmacotherapy as helpful. During AGnES 2 + 3 local pharmacists identified DDIs in 45% of patients. Seven patients (11.6%) reported at least one ADR attributable to their current medication. Those patients who received a second HMR (n = 29) during AGnES 2 + 3 rated the HMR as reasonable 65.5% (n = 19), and partly reasonable 24.1% (n = 7). Conclusions By comprehensive HMR conducted by AGnES-practice assistants in delegation of the patients’ GPs in cooperation with local pharmacists we could identify a considerable prevalence of DRP under real-life conditions. Further studies should recruit more participants including a control group with usual care.
KeywordsAdverse drug event Drug interactions Drug utilization review Germany Health professional network Medication non-adherence Self medication
We are grateful to all local pharmacies and GPs for the evaluation of the data transfer sheets and their central role in the implementation of HMR and pharmaceutical care. Neither the local pharmacists nor the GPs received any payment for their participation in the study. We wish to thank them, and no less all participating patients and AGnES practice assistants for their continuous cooperation, and valuable advice. We are grateful to the GSF scientific centre Neuherberg (Dr. M. Dietz and I. Mair) for licensing the IDOM database and the AOK Research Institute (WIdO) for licensing the German Drug Index. Thomas Fiss received a research fellow ship from the German National Academic Foundation.
This project was funded by the Ministry of Health of the Federal State of Mecklenburg-Western Pomerania. The study sponsors did not have any involvement in conducting of the study.
Conflicts of interest
- 2.Gerlach F, Kuhlmey A, Glaeske G, Rosenbrock R, Wille E, Haubitz M et al. Koordination und Integration—Gesundheitsversorgung in einer Gesellschaft des längeren Lebens. Sondergutachten des Sachverständigenrates zur Begutachtung der Entwicklung im Gesundheitswesen 2009 (Coordination and integration—health care supply in an ageing society. Expert opinion of the expert advisory board of the German health care system). 2009. http://www.svr-gesundheit.de/Gutachten/Uebersicht/GA2009-LF.pdf. Accessed June 2010.
- 4.Statistisches Landesamt Mecklenburg-Vorpommern. Statistisches Jahrbuch Mecklenburg-Vorpommern 2005 (Statistical yearbook Mecklenburg-Western Pomerania 2005). 1st ed. Schwerin: cw Obotritendruck GmbH; 2005. ISBN 3931654184.Google Scholar
- 6.Kopetsch T. Ärztemangel in Deutschland und Mecklenburg-Vorpommern (lack of doctors in Mecklenburg-Western Pomerania). Ärztebl Mecklenbg Vorpommern. 2004;2004:41–8.Google Scholar
- 16.van den Berg N, Fiss T, Meinke C, Heymann R, Scriba S, Hoffmann W. GP-support by means of AGnES-practice assistants and the use of telecare devices in a sparsely populated region in Northern Germany—proof of concept. BMC Fam Pract. 2009;44:1–8.Google Scholar
- 17.Fiss T, Ritter C, Hofmann W. Neues Konzept zur ambulanten pharmazeutischen Betreuung (New concept for ambulatory pharmaceutical care). Dtsch Apoth Ztg. 2007;147:2771–2.Google Scholar
- 19.Schaefer M, Schulz M, Emmermann A, Mühlbauer K, Verheyen F. Manuale zur Pharmazeutischen Betreuung-Band 1: Grundlagen der Pharmazeutischen Betreuung (Manual for pharmaceutical care—basic principle of pharmaceutical care). ABDA-Bundesvereinigung Deutscher Apotheker GOVI-Verlag Eschborn; 2000. ISBN 9783774108448.Google Scholar
- 21.Gerdemann A, Griese N, Schulz M. Der Interaktions-Check in der Apotheke (The check for drug-drug-interactions in the community pharmacy). Pharm Ztg. 2007;152:3522–4.Google Scholar
- 22.Zagermann-Muncke P ABDA-Datenbank: Welche Interaktionen werden aufgenommen? (The ABDA-database: which drug-drug-interactions get included?). Pharm Ztg 2003. http://www.webcitation.org/5nlBwHRFk. Accessed June 2010.
- 23.Zagermann-Muncke P. ABDA-Datenbank als Wegweiser im Wechselwirkungsdschungel (The ABDA-database). Pharm Ztg. 2009;154:26–8.Google Scholar
- 25.ATC/DDD-ROM. Anatomic-therapeutic-chemical classification with DDD for German marked. GKV Drug index. Data status: May 2008. http://www.dimdi.de/static/en/amg/atcddd/index.htm. Accessed June 2010.
- 26.American Society of Hospital Pharmacists. ASHP statement on pharmaceutical care. Am J Hosp Pharm. 1993;50:1720–3.Google Scholar
- 27.American Society of Health System Pharmacists. Survey reveals patient concerns about medication-related issues. http://www.webcitation.org/5iPNvMLob. Accessed June 2010.
- 28.Australian Association of Consultant Pharmacy. The facts on accreditation and remuneration for medication reviews—fact sheet no.2. http://www.webcitation.org/5iQfRIxmH. Accessed June 2010.
- 29.Emerson L Implementing home medication reviews in Australia: experience to date. ABDA-Bundesvereinigung Deutscher Apothekerverbände. 2009. http://www.webcitation.org/5iR0qDpV8. Accessed June 2010.
- 34.Petty DR, Zermansky AG, Raynor DK. Evidence shows medication reviews by pharmacists point way forward. Pharm J. 2001;267:863–4.Google Scholar
- 38.Bullinger M, Kirchberger I SF-36 Fragenbogen zum Gesundheitszustand (SF-36 Questionnaire about health related quality of life). 1998. http://www.webcitation.org/5qKWnBczF. Accessed June 2010.