Effects of a three party healthcare network on the incidence levels of drug related problems
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Background Drug related problems (DRPs) are impairing patients’ health and cause high costs. Neither delegation of home medication review nor regular pharmaceutical care are common in Germany. Objective We aimed to reduce several DRP by the implementation of a three party healthcare team [AGnES-practice assistant, pharmacist, general practitioner (GP)] and adherence supporting strategies (using a medication reminder chart, medication compliance aid). Setting The setting was ambulatory primary healthcare in German rural areas with a cohort of home-dwelling, elderly, mostly multimorbid patients with limited mobility (study period: 06/2006–12/2008). Methods We conducted a prospective non-randomized implementation cohort study with home medication review (home medication review module; mean participation time: 9 months). Data collection was delegated to additionally qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted systemic intervention). The intervention comprised pharmaceutical care by the local pharmacy in addition to medical interventions by the GP. 408 patients (mean age: women: 80.7 years; men: 75.3 years) received both pharmaceutical care and at least one follow-up visit. Main outcome measurement Outcome measurements comprised self-reported DRPs, objectively evaluated DRP, and prevalence of adherence supporting strategies. Results The three party healthcare team approach reduced self-reported forgetfulness (7.7–3.2 %; p = 0.001), the proportion of patients with intermittent drug intake (5.3–1.3 %; p < 0.001), and the proportion of patients with potentially clinical relevant drug–drug interaction (61.6–51.2 %; p < 0.001). Self-reported adverse drug reactions decreased non-significantly (5.4–4.6 %; p = 0.564; all tests χ2-McNemar). The median number of active substances taken was reduced from 8 to 7 (p < 0.001; Wilcoxon signed rank test). The proportions of patients using medication charts and compliance aids increased significantly (75.2–90.3 %; p < 0.001) and (70.0–80.1 %; p > 0.001), respectively. Conclusion This is the first study evaluating effects of a three party team on DRPs in a primary healthcare setting in Germany. This approach led to reduction in the occurrence of several DRPs and improved adherence supporting strategies. However, the study is a pre-post analysis, and had no control group.
KeywordsAdverse drug events Drug–drug interaction Drug related problem Germany Health services research Home medication review Interprofessional cooperation Potentially inappropriate medication
We are grateful to all local pharmacies, GPs, and AGnES-practice assistants for their active role in the implementation of pharmaceutical care. We are grateful to the GSF scientific centre Neuherberg for licensing the IDOM database and the AOK Research Institute (WidO) for licensing the German Drug Index.
The AGnES-projects were funded by the following institutions: Ministry of Health of the Federal State of Mecklenburg-Western Pomerania, the Ministry for Labour, Social Affairs, Health and Family of the Federal State of Brandenburg, the Saxony State Ministry of Social Affairs, the Ministry of Health and Social Affairs of the Federal State Saxony-Anhalt, the Regional Association of Statutory Health Insurance Physicians, various regional Statutory Health Insurances and the European Social Fund. The first author (TF) was supported by a research fellowship granted by the German National Academic Foundation (Studienstiftung des Deutschen Volkes).
Conflicts of interest
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