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Medication assessment tool to detect care issues from routine data: a pilot study in primary care

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Abstract

Background Medication assessment tools (MATs) may be implemented in routine electronic data sources in order to identify patients with opportunities for optimisation of medication therapy management (MTM) and follow-up by a multi-disciplinary team. Objective (1) To demonstrate the use of a MAT for cardiovascular conditions (MATCVC) as a means of profiling potential opportunities for MTM optimisation in primary care and (2) to assess the performance of MATCVC in identifying actual opportunities for better care. Setting Members of a pharmacotherapy discussion group, i.e. two single-handed general practitioners (GPs), three GP partners, and community pharmacists (CPs) from each of two community pharmacies, in a rural part of the Netherlands. Methods MATCVC comprises 21 medication assessment criteria, each of which is designed to detect a specific care issue and to check whether it is ‘addressed’ by provision of guideline recommended care or ‘open’ in the presence (‘open explained’) or absence (‘open unexplained’) of pre-specified explanations for guideline deviations. (1) Relevant data was extracted from linked GP and CP electronic records and MATCVC assessment was conducted to profile the population of CVC patients registered with both, participating CPs and GPs, in terms of ‘open unexplained’ care issues. (2) A purposive sample of patients with ‘open unexplained’ care issues was reviewed by each patient’s GP. Main outcome measures Number and proportion of ‘open unexplained’ care issues per MATCVC criterion and per patient. The number of patients with MATCVC detected ‘open unexplained’ care issues to be reviewed (NNR) in order to identify one that requires changes in MTM. Results In 1,876 target group patients, MATCVC identified 6,915 care issues, of which 2,770 (40.1 %) were ‘open unexplained’. At population level, ten MATCVC criteria had particularly high potential for quality improvement. At patient level, 1,277 (68.1 %) target group patients had at least one ‘open unexplained’ care issue. For patients with four or more ‘open unexplained’ care issues, the NNR was 2 (95 % CI 2–2). Conclusion The study demonstrates potential ways of using MATCVC as a key component of a collaborative MTM system. Strategies that promote documentation and sharing of explanations for deviating from guideline recommendations may enhance the utility of the approach.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

AF:

Atrial fibrillation

ARB:

Angiotensin receptor blocker

BB:

Beta blocker

BP:

Blood pressure

CCB:

Calcium channel blocker

CE:

Clinical explanation

CHADS2 :

Stroke risk stratification tool in atrial fibrillation, where congestive heart failure, hypertension, age >75 and diabetes mellitus score 1 point each and a history of stroke or transient ischaemic attack score 2 points. A score of 0 is deemed ‘low’, a score of 1 ‘intermediate’ and a score of ≥2 ‘high’ risk

CHD:

Coronary heart disease

CHF:

Chronic heart failure

CI:

Confidence interval

CP:

Community pharmacist

CVC:

Cardiovascular condition

CVD:

Vascular disease comprising peripheral vascular disease, history of stroke or transient ischaemic attack and coronary heart disease or history of acute coronary syndrome

DM:

Diabetes mellitus

eGFR:

Estimated glomerular filtration rate

GP:

General practitioner

HbA1c:

Glycosylated haemoglobin

HTN:

Hypertension

ICPC:

International classification of primary care

MAT:

Medication assessment tool

MI:

Myocardial infarction

MTM:

Medication therapy management

NNR:

Number needed to review

OAC:

Oral anticoagulant

PAD:

Peripheral vascular disease

RASI:

Renin angiotensin system inhibitor

TIA:

Transient ischaemic attack

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Acknowledgments

We would like to thank all general practitioners and community pharmacy staff, who participated in this study. This study would not have been possible without Professor Steve Hudson, who sadly passed away during the preparation of this paper.

Funding

The study was conducted without specific external funding. During the conduct of this study, T.D. was supported by personal grants from the Harold and Marjorie Charitable Trust, Dr. Anni and Dr. August Lesmueller Stiftung and the University of Strathclyde, Glasgow.

Conflicts of interest

The authors declare they have no conflicts of interest.

Author information

Authors and Affiliations

  1. NHS Tayside c/o Division of Population Health Sciences, University of Dundee, Dundee, Scotland, UK

    Tobias Dreischulte

  2. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK

    Julienne Johnson & Steve Hudson

  3. NHS 24, South Queensferry, Scotland, UK

    John McAnaw

  4. Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands

    Marlies Geurts & Han de Gier

Authors
  1. Tobias Dreischulte
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  2. Julienne Johnson
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  4. Marlies Geurts
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  5. Han de Gier
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  6. Steve Hudson
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Corresponding author

Correspondence to Tobias Dreischulte.

Additional information

Steve Hudson: Deceased.

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Dreischulte, T., Johnson, J., McAnaw, J. et al. Medication assessment tool to detect care issues from routine data: a pilot study in primary care. Int J Clin Pharm 35, 1063–1074 (2013). https://doi.org/10.1007/s11096-013-9828-2

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