Detection of drug related problems in an interdisciplinary health care model for rural areas in Germany |
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Authors: | Thomas Fiss Christoph Alexander Ritter Dietrich Alte Neeltje van den Berg and Wolfgang Hoffmann |
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Institution: | (1) Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Ellernholzstr. 1-2, 17487 Greifswald, Germany;(2) Institute of Pharmacy, Ernst Moritz Arndt University of Greifswald, F.-Ludwig-Jahn-Str.17, 17487 Greifswald, Germany;(3) Institute for Community Medicine, Ernst Moritz Arndt University of Greifswald, Walter-Rathenau-Str. 48, 17475 Greifswald, Germany |
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Abstract: | 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. |
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