Treating <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> infections in an intensive care unit at a University Hospital in Brazil

Background Optimizing antimicrobial therapy is important for treating patients who are critically ill with Staphylococcus aureus infection, and susceptibility tests are necessary. Objective The aim of the present study was to evaluate antibacterial therapy after susceptibility testing of S. aureus infections. Setting The setting was an intensive care unit at a University Hospital in Brazil. Methods An observational and retrospective study was conducted over 6 years. The antimicrobials that were used for S. aureus infection treatment were calculated as the defined daily dose per 1000 patient-days (DDD₁₀₀₀). Antimicrobial susceptibility data were obtained by reviewing bacteriological tests. Patient profiles and treatment were determined by analyzing patient charts. Results Methicillin-resistant S. aureus (MRSA) was prevalent in this study (76.13 %). Patients who were infected with MRSA had total antimicrobial consumption that was three-times higher (9567.2 DDD₁₀₀₀) than patients who were infected with methicillin-susceptible S. aureus (MSSA; 3101.1 DDD₁₀₀₀). The average length of stay in the intensive care unit was 19 days (interquartile range 17 days) for MSSA and 20 days (interquartile range 20 days) for MRSA. Mortality in patients who were infected with MSSA was higher (52.17 %) than in patients who were infected with MRSA (33.80 %), and de-escalation was not identified in 73.90 % of MSSA patients.     

The use of a low dose hydrocortisone to prevent pulmonary embolism in patients with multiple trauma

Background Venous thromboembolism events are common in trauma patients. Immediate acute inflammation following injury triggers coagulation cascade and may increase the risk of pulmonary embolism (PE) in this population. Objective We aimed to evaluate whether early low-dose steroids prevent symptomatic PE onset in multiple trauma patients. Setting The medical surgical intensive care unit of Habib Bourguiba University Hospital (Sfax—Tunisia). Methods Comparative study of two cohorts: a retrospective cohort of patients who didn’t receive early low-dose steroids (steroid (?) group) and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 h for a scheduled period of 7 days (steroid (+) group). All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 h were included. Main outcome measure Evaluation of the impact of low-dose steroids on the incidence of symptomatic PE. Results We included 175 patients: 92 in the steroids (?) group and 83 in the steroids (+) group. PE was diagnosed in 15 patients (8.5 %). The incidence of PE was significantly lower in steroid (+) group (3.6 vs 13 %; p = 0.013). In multivariate analysis, independent factors predicting PE onset were meningeal hemorrhage [OR = 14.7; 95 % CI (2.2–96.3); p = 0.013] and pelvic ring trauma [OR = 8; 95 % CI (1.8–36.4); p = 0.007] whereas low-dose steroids were significantly associated with a protective effect [OR = 0.2; 95 % CI (0.05–0.77); p = 0.019]. There was no significant difference between steroids (+) and steroids (?) groups neither in terms of mean ICU length of stay (LOS) (respectively 11 ± 9.7 and 12.3 ± 10.7 days; p = 0.372) nor in terms of ICU mortality (respectively 29.3 and 24.1 %; p = 0.434). Conclusion Steroids are effective in reducing the incidence of PE in multiple trauma patients. However, no significant benefice was found on ICU mortality.     

Effects of N-Acetylcysteine on the Cardiac Remodeling Biomarkers and Major Adverse Events Following Acute Myocardial Infarction: A Randomized Clinical Trial

Aims

The aims of this study were to evaluate the effects of N-acetylcysteine (NAC) on cardiac remodeling and major adverse events following acute myocardial infarction (AMI).

Methods

In a prospective, double-blind, randomized clinical trial, the effect of NAC on the serum levels of cardiac biomarkers was compared with that of placebo in 98 patients with AMI. Also, the patients were followed up for a 1-year period for major adverse cardiac events (MACE), including the occurrence of recurrent myocardial infarction, death, and need for target vessel revascularization.

Results

In patients who received NAC, the serum levels of matrix metalloproteinase (MMP)-9 and MMP-2 after 72 h were significantly lower than those in the placebo group (p = 0.014 and p = 0.045, respectively). The length of hospitalization in patients who received NAC was significantly shorter than that in the placebo group (p = 0.024). With respect to MACE, there was a significant difference between those who received NAC (14 %) and those patients on placebo (25 %) (p = 0.024). Re-infarction took place in 4 % of patients in the NAC group as compared with 16.7 % in patients who received placebo (p = 0.007).

Conclusion

NAC can be beneficial in preventing early remodeling by reducing the level of MMP-2 and MMP-9. Moreover, NAC decreased the length of hospital stays in patients after AMI. By decreasing MACE, NAC could possibly be introduced as a ‘magic bullet’ in the pharmacotherapy of patients with AMI. Further studies are needed to elucidate NAC’s role in this population.     

Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial

Background Brazilians with type 2 diabetes require action to improve haemoglobin A1C levels considering the fact that approximately 73 % of them have poor glycaemic control. Evidence has shown the potential benefits of pharmaceutical care programs in type 2 diabetes patients. Objective To evaluate the effect of a pharmaceutical care program on blood glucose, blood pressure and lipid profile in hyperglycaemic patients undergoing drug treatment for type 2 diabetes. Setting Six primary care units of the Brazilian public health system, Ouro Preto, Brazil. Method An open, randomised, controlled clinical trial was conducted for 6 months. Subjects aged 18 years or older who were using oral antidiabetic medications and presenting haemoglobin A1C levels ≥7 % were randomly assigned to receive only usual health care or usual health care plus pharmaceutical intervention. Main outcome measure Haemoglobin A1C. Results A total of 129 subjects were enrolled, and 100 patients completed the study. Compared to the control group (n = 50), the intervention group (n = 50) showed a significant reduction of haemoglobin A1C (?0.6 vs 0.7 %, p = 0.001), fasting plasma glucose, total cholesterol, LDL cholesterol, triglycerides and systolic blood pressure and a significant increase in HDL cholesterol and the use of lipid-modifying agents and platelet aggregation inhibitors. Conclusions This study suggests that a pharmaceutical care program may provide important contributions to reduce haemoglobin A1C in type 2 diabetes patients. Moreover, the promotion of the rational use of drugs may be better achieved in a context of pharmaceutical care programs in Brazil.     

Influence of pharmaceutical care on the delayed emesis associated with chemotherapy

Background Complete control of emesis during chemotherapy remains to be achieved. This could be improved by increasing adherence to medicines and recommendations. Objective The aim of this study was to analyse the effects of pharmaceutical care on the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in adult cancer outpatients. Method This is a longitudinal prospective intervention study. Patients included were those who received a new cancer intravenous treatment. We compared complete response (no vomiting and no rescue treatment) and the incidence of nausea in the control group (CG) and in the intervention group (IG), as well as patients’ adherence. Pharmaceutical intervention consisted of: reviewing the antiemetic protocol and giving some recommendations to the patients. Results 102 patients were studied. In the delayed phase complete response was achieved in 84.8 % of the patients in the IG, compared with 69.6 % in the control group [absolute risk reduction (ARR), 15.2 %; p = 0.144]. Regarding absence of vomiting, the difference was higher (71.0 CG vs 97.0 % IG, ARR, 26.0%; p = 0.002). Absence of delayed nausea were also better in the IG (61 vs. 52 %). Compliant patients increased from 59 to 76 %. Conclusion The intervention of a pharmacist reduced the incidence of delayed CINV and improved medication adherence.     

Outcomes of pharmacist-provided medication review in collaborative care for adult Singaporeans receiving hemodialysis

Background Patients receiving hemodialysis are predisposed to drug related problems (DRPs). While collaborative care (CC) models with pharmacist involvement can reduce DRP occurrence, few have examined its impact on clinical and economic outcomes. Objective To determine whether a CC model with pharmacist-provided medication review can reduce unplanned admissions and healthcare utilization in patients receiving hemodialysis, compared to usual care (UC). Setting Outpatient nephrology clinic of a tertiary hospital in Singapore. Method In this retrospective observational study, patients who were taking more than 10 medications or had prior unplanned admissions were included. Patients were identified as being managed under CC (n = 134) if they received comprehensive pharmacist-provided review, or under the UC (n = 190) if they did not. Those perceived to be at greater risk were given priority for receiving CC. All outcomes analyses were adjusted for covariates. Main outcome measure The primary outcome was incidence of unplanned admissions within 6 months post index visit. Secondary outcomes included length of stay (LOS), mortality and healthcare utilization cost. Results CC reduced unplanned admissions by 27% (IRR 0.73, 95% CI 0.54–0.99, p = 0.047) and shortened mean LOS by 1.3 days [6.7 (2.6) vs. 8.0 (3.2), p < 0.001] compared to UC. There were no significant differences in mortality (p = 0.189) or mean healthcare utilization cost (p = 0.165) between groups. Pharmacists identified 515 DRPs with 429 (83.3%) resolved after review. Conclusion The CC model with pharmacist-provided medication review reduced unplanned admissions and LOS in patients receiving hemodialysis. Further studies are warranted to confirm reductions in mortality and healthcare utilization.     

The effect of intravenous isosorbide dinitrate in acute decompensated heart failure in hospital

Background According to new recommendations for the management of acute decompensated heart failure (ADHF) in 2015, intravenous vasodilator therapy might be given as an early therapy when systolic blood pressure is normal to high (≥110 mmHg). Only 29% of patients with ADHF are treated with vasodilators without medical contraindication. Objective To evaluate the effect of the systematic use of ISDN on ADHF without contraindication especially on rehospitalization rate. Settings The 600-bed hospital (Centre Hospitalier de l’Ouest Vosgien, Neufchâteau, France). Methods This is a retrospective study with data analysed from medical records. Patients with ADHF episodes and hospitalization in the cardiology department or intensive care unit (ICU) between November 2013 and December 2015 were included resulting in 199 hospitalizations in the analysis (37 were treated by ISDN, and 162 were not). Main outcome measure Effects of ISDN on 180-day hospital readmission for ADHF or acute myocardial infarction (AMI), in-hospital mortality, length of stay, number of ICU admissions, and ICU length of stay. Results Patients who received ISDN required more ICU admissions than the other patients (54.1 vs 33.3%, p = 0.02). Nevertheless 180-day hospital readmission was lower for patients who were receiving ISDN (8.1 vs 22.8%, p = 0.04). ISDN did not influence other clinical outcomes tested. Conclusion ISDN may minimize or prevent the consequences of altered haemodynamics. Lower rehospitalization rate with ISDN was seen in this study.     

Exploring medical student education initiatives: does the management of urologic conditions improve with a formal urology clinical clerkship?

Recent studies suggest a consistent decline of formal urological education in medical schools. We sought to determine whether a standardized urology curriculum improves student clinical knowledge. A confidential questionnaire was distributed to two groups of clinical medical students following the completion of their third year: one with no urology rotation (non-GU) and another with a 2-week urology clinical clerkship (GU). The survey included questions pertaining to topics within general urology, and it also addressed their comfort with Foley catheter placement. Differences between cohorts were assessed by the Fisher exact test. In total, 131 GU students and 56 non-GU students completed surveys. More GU students felt comfortable placing a Foley catheter (p < 0.001). Additionally, more students in the non-GU group believed that patients aged 70–74 (p = 0.047), 75–79 (p < 0.001) and older than 80 years (p < 0.001) should receive routine PSA screening. More non-GU students attempted to use antibiotics in the evaluation of hematuria (microscopic: female p < 0.001, male p = 0.002; gross: female: p = 0.009, male: p = 0.009). GU students more often checked urine cytology in a 52-year-old man with microhematuria (p = 0.018). Non-GU students more often initiated a urology consult in patients with hematuria and LUTS, respectively (male patients: p = 0.034, p = 0.069; female patients: p = 0.025, p = 0.027). Students with a dedicated urology clerkship exhibited significant improvements in procedural patient care, PSA screening guidelines, hematuria management, as well as judicious antibiotic use. These results corroborate the importance of a dedicated urology curriculum within standard medical school education.     

Impact of pharmaceutical care on pain and agitation in a medical intensive care unit in Thailand

Background Currently, a lack of pharmaceutical care exists concerning pain and agitation in medical intensive care units (MICU) in Thailand. Pharmaceutical care focusing on analgesics/sedatives would improve clinical outcomes. Objective To investigate the impact of pharmaceutical care of pain and agitation on ICU length of stay (LOS), hospital LOS, ventilator days and mortality. Setting The MICU of a university hospital. Method A before/after study was conducted on mechanically ventilated patients receiving analgesics/sedatives. Medical chart reviews and data collection were conducted in the retrospective group (no pharmacists involved). In the prospective group, pharmacists involved with the critical care team helped select analgesics/sedatives for individual patients. Main outcome measure ICU LOS Results In total, 90 and 66 patients were enrolled in retrospective and prospective groups, respectively. The median duration of ICU LOS was reduced from 10.00 (2.00–72.00) in the retrospective group to 6.50 days (2.00–30.00) in the prospective group (p = 0.002). The median hospital stay was reduced from 30.50 days (2.00–119.00) in the retrospective group to 17.50 days (2.00–110.00) in the prospective group (p < 0.001). Also, the median ventilator days was reduced from 14.00 days (2.00–90.00) to 8.50 days (1.00–45.00), p = 0.008. Mortality was 53.03% in the prospective group and 46.67% in the retrospective group (p = 0.432). Conclusion Pharmacist participation in a critical care team resulted in a significant reduction in the duration of ICU LOS, hospital LOS and ventilator days, but not mortality.     

Retrospective analysis of the risk factors for linezolid-induced thrombocytopenia in adult Japanese patients

Background Thrombocytopenia is a major side effect of linezolid therapy. However, there are few reports about the risk factors for linezolid-induced thrombocytopenia. Objective The aim of this study is to evaluate the risk factors for thrombocytopenia in patients who undergo linezolid therapy. Setting Aomori Prefectural Central Hospital in Japan, a tertiary 695 beds hospital. Method A retrospective review was performed using the hospital’s medical records. From January 2010 to August 2012, 75 adult patients who received linezolid therapy were enrolled in this study. Main outcome measure Linezolid-induced thrombocytopenia was defined as a decrease in the patient’s platelet count to <10 × 10⁴/μL or a reduction of ≥30 % from their baseline value. Odds ratios (OR) for thrombocytopenia were analyzed using multivariate stepwise logistic regression analysis. Results Thrombocytopenia occurred in 29 patients (38.6 %), seven of whom required platelet transfusions. The patients who developed thrombocytopenia were significantly older, displayed a significantly higher frequency of renal insufficiency, and received linezolid therapy for significantly longer than the patients without thrombocytopenia. Stepwise logistic regression analysis suggested that receiving linezolid therapy for ≥14 days was a significant risk factor for thrombocytopenia [OR 13.3, 95 % confidence interval (CI) 3.2–55.6, p < 0.01], whereas the creatinine clearance rate exhibited a significant negative correlation with the incidence of the condition [OR 0.98, 95 % CI 0.96–0.99, p = 0.037]. The incidence of thrombocytopenia among the patients who demonstrated creatinine clearance rates of <30 mL/min was 60 % (12/20), which was significantly higher than that observed among the patients who displayed creatinine clearance rates of more than 60 mL/min (26.4 %, 9/34, p = 0.014). Conclusion Receiving linezolid therapy for ≥14 days and a low creatinine clearance rate were suggested to be risk factors for linezolid-induced thrombocytopenia. The platelet counts of patients with these risk factors should be closely monitored.     

Potential drug–drug interactions in internal medicine wards in hospital setting in Pakistan

Background Multiple drugs therapies may be the potential source of drug–drug interactions that can result in alteration of therapeutic response and/or increase untoward effects of many drugs. Objective To identify the frequency and levels of potential drug–drug interactions (pDDIs) in internal medicine wards and their association with patients’ age, gender, length of hospital stay and number of prescribed medications; and to describe management of frequently identified major or moderate pDDIs. Setting Internal medicine wards of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. Method Micromedex Drug-Reax system was used to screen patient’s profiles for pDDIs. Logistic regression was applied to determine the odds ratio for specific risk factors of pDDIs i.e., age, gender, hospital-stay and number of medications. Main outcome measure Overall prevalence and prevalence of contraindicated, major, moderate and minor pDDIs; levels of pDDIs; frequently identified major or moderate interactions; and odds ratios for risk factors. Results Total, 188 interacting drug-combinations were identified that contributed to 675 pDDIs. Of 400 patients, 52.8 % patients were presented with at least one pDDI (overall prevalence), 21.3 % with at least one major-pDDI, and 44.3 % with at least one moderate-pDDI. Of 675 pDDIs, most were of moderate (63.6 %) or major severity (23 %); good (61.2 %) or fair (25.5 %) type of scientific evidence; and delayed onset (50.2 %). Most frequently identified major or moderate interactions resulted in 45.3 % of all pDDIs. Their potential adverse outcomes included hepatotoxicity, bleeding, ototoxicity, nephrotoxicity, hypoglycemia, hyperglycemia, risk of thrombosis, hypotension, cardiac arrhythmias and reduction in therapeutic-effectiveness. There was significant association of the occurrence of pDDIs with patients’ age of 60 years or more (OR = 2.1; 95 % CI = 1.3–3.3; p = 0.003), hospital stay of 6 days or longer (OR = 2.6; 95 % CI = 1.5–4.5; p = 0.001), and seven or more number of prescribed medications (OR = 5.9; 95 % CI = 3.6–9.6; p < 0.001). Conclusion The present study has recorded a high prevalence of pDDIs in internal medicine wards. Patients with old age, longer hospital stay and increased number of prescribed medications were at higher risk.     

Levetiracetam versus phenytoin for seizure prophylaxis in brain injured patients: a systematic review and meta-analysis

Background The onset of early and/or late seizures in brain injured patients is associated with worse outcome. So far, phenytoin is the most commonly used antiepileptic drug to prevent seizures in this group of patients. Objective In the current metaanalysis, we aimed to compare the efficacy and safety of phenytoin versus levetiracetam for seizure prophylaxis in brain injured patients. Methods A systematic search was conducted in PubMed and Cochrane Library Database by 2 investigators. Four randomized controlled trials (RCTs) were included (295 patients). Data were extracted and the quality of each RCT was assessed. Results Levetiracetam was found to be more effective than phenytoin in seizure prophylaxis (OR = 0.23; CI 95% [0.09–0.56]; Q test p value = 0.18 and I² = 38%). A trend toward less serious side effects was also found in patients treated with levetiracetam (OR = 0.27; CI 95% [0.07–1.07]; Q test p value = 0.72 and I² = 0%). Conclusion Levetiracetam is more effective and safer than phenytoin for seizure prophylaxis in brain injured patients.     

Antihypertensive Efficacy of Triple Combination Perindopril/Indapamide Plus Amlodipine in High-Risk Hypertensives: Results of the PIANIST Study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients)

Objective

Our objective was to evaluate a triple-drug antihypertensive strategy for blood pressure control in patients with difficult-to-treat hypertension.

Design

The Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients (PIANIST) trial was an observational, 4-month, open-label study.

Patients and interventions

A total of 4,731 patients at high or very high cardiovascular risk with hypertension that was not properly controlled despite antihypertensive therapy, and for whom study treatment (fixed-dose perindopril 10 mg/indapamide 2.5 mg + amlodipine 5 or 10 mg) was consistent with their existing therapeutic plan, were included.

Outcomes

One-sample t tests and Chi-squared tests were performed to evaluate changes in blood pressure.

Results

Mean baseline office blood pressure (OBP) was 160.5 ± 13.3/93.8 ± 8.7 mmHg. After 4 months of therapy, OBP decreased by 28.3 ± 13.5/13.8 ± 9.4 to 132.2 ± 8.6/80.0 ± 6.6 mmHg (p < 0.0001). Blood pressure targets were reached by 72.0 % of patients and by 81 and 91 % of patients previously treated with an angiotensin-converting enzyme inhibitor/hydrochlorothiazide or an angiotensin receptor blocker/hydrochlorothiazide, respectively. Changes in OBP were 18.7 ± 8.3/9.7 ± 7.2 mmHg for grade 1 (n = 1,679), 30.4 ± 10.1/14.7 ± 8.6 mmHg for grade 2 (n = 2,397), and 45.4 ± 15.1/20.7 ± 12.1 mmHg for grade 3 patients (n = 655; all p < 0.0001). In patients who underwent ambulatory blood pressure monitoring (n = 104), 24-h mean blood pressure decreased from 147.4 ± 13.8/82.1 ± 11.9 to 122.6 ± 9.1/72.8 ± 7.4 mmHg (p < 0.0001). Ankle edema was infrequent (0.2 % of patients).

Conclusion

Triple combination perindopril/indapamide/amlodipine was effectively and safely administered to a large population of high- and very high-risk hypertensive patients who had not reached target OBP values with previous treatment.     

Drug utilization pattern and cost for the treatment of severe sepsis and septic shock in critically ill cancer patients

Background Cancer patients are at high risk for developing sepsis. To our knowledge, there are no studies that evaluated the type of medications utilized and the associated cost in cancer patients with severe sepsis and septic shock. Objective To describe the drug utilization pattern and drug cost in the treatment of cancer patients with severe sepsis and septic shock. Setting 12-bed medical/surgical intensive care unit (ICU) of a comprehensive teaching cancer center. Methods A retrospective cohort study of cancer patients with severe sepsis or septic shock who were treated in the ICU between January and December, 2010. The ICU sepsis database was used to identify patients. The patient demographics and characteristics were recorded. In addition, the number and type of prescribed medications, total cost for each medication, type of infection, and culture results were determined. Main outcome measure The main outcomes were the type of medication classes utilized and the cost of the medications. Results During the study period, 116 cases were identified. Upon presentation, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21.8 (SD ±7.8), 30 (25.9 %) patients had neutropenia, and 94 (81 %) had positive cultures. The total cost of the medications prescribed for this cohort of patients was 291,030 Euro. The mean number of medications prescribed per patient and the mean total cost per patient were 11.7 (SD ±4.7) and 2,509 Euro (SD ±2,844), respectively. The most commonly prescribed medication classes were acid suppressive therapy, glycopeptides, penicillins/cephalosporins and vasopressors prescribed in 113 (97 %), 104 (89.7 %), 103 (88.9 %), and 102 (88 %) patients, respectively. The highest medication costs were associated with antifungals (mean 1,288 Euro/patient) and colony stimulating factors (mean 829 Euro/patient), prescribed in 55 (47.4 %) and 37 (31.9 %) patients, respectively. Medication costs were higher in non-survivors, compared to survivors (3,664 Euro vs. 1,430 Euro, p = 0.0001), and in patients with positive cultures, compared to patients with negative cultures (3,198 Euro vs. 1,865 Euro, p = 0.0004). Conclusion In cancer patients with severe sepsis and septic shock, multiple medications are prescribed which are associated with high cost.     

Effects of a three party healthcare network on the incidence levels of drug related problems

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.