gms | German Medical Science

15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Cluster-Randomized Controlled Trial for the improvement of medication safety for patients with chronic kidney disease in general practice [ISRCTN02900734] (BMBF reference No. 01GK0302)

Cluster-randomisierte Interventionsstudie zur Erhöhung der Verordnungssicherheit bei Patienten mit chronischer Niereninsuffizienz in der Hausarztpraxis

Meeting Abstract

  • corresponding author Antje Erler - Institute for General Practice, Goethe-University Frankfurt am Main
  • M. Beyer - Institute for General Practice, Goethe-University Frankfurt am Main
  • K. Saal - Institute for General Practice, Goethe-University Frankfurt am Main
  • J. Petersen - Institute for General Practice, Goethe-University Frankfurt am Main
  • T. Rath - Institute for Health Economy and Clinical Epidemiology, University Hospital Cologne
  • J. Rochon - Center for Clinical Studies, University Regensburg
  • C. Zint - Department of Internal Medicine VI - Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg
  • W.E. Haefeli - Department of Internal Medicine VI - Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg
  • F.M. Gerlach - Institute for General Practice, Goethe-University Frankfurt am Main

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gaa2008/08gaa08.shtml

Veröffentlicht: 6. November 2008

© 2008 Erler et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Background and aim: As old age and diagnoses common in GP practice (hypertension, diabetes) are major risk factors, chronic kidney disease (CKD) is a frequent condition in primary care patients. However, the identification of these patients and the calculation of their correct medication dosage can be complicated and time-consuming for GPs in daily practice, and this may result in inappropriate and potentially harmful prescriptions. The aim of this study was to examine whether medication safety for patients with CKD can be improved through the use of a CD-based software tool that allows the easy calculation of renal function and provides guidance on dosage reduction (“DOSING”).

Material and method: Cluster-randomised controlled trial in 44 general practices, randomly allocated to intervention or control groups receiving usual care. We randomly selected 5 study patients per group and practice from all patients with an ICD-10-diagnosis code for CKD (group A) or for hypertension and aged > 69 (group B) and a creatinine clearance < 50 ml/min (according to the Cockroft-Gault formula). We reviewed the patients’ medication at baseline and at the end of the intervention period after 6 months. The main outcome measure was the percentage of prescription dosages that were more than 30% higher than recommended by the software tool DOSING at the end of the intervention period. In addition, qualitative interviews were conducted with GPs in the intervention group which evaluated the user-friendliness and applicability of the software tool DOSING in daily practice.

Results: 44 GP practices and 404 patients participated in the study (4-13 patients/practice). In group A (n=211) the software tool DOSING suggested an individualized drug dosage for 20% and in group B (n=193) for 22% of all drugs prescribed, mainly for ACE inhibitors, ß-blockers, allopurinole, and antibiotics. At the outset, every second dosage of these drugs was found to be more than 30% higher than DOSING recommended in groups A and B. After 6 months, the number of prescriptions foreseeing a drug dosage more than 30% higher than recommended was 4% lower in the intervention group compared to the control group in group A and 9% lower in group B.

Overall, GPs in the intervention group considered the software tool DOSING as helpful. However, a prerequisite for its regular use is its integration into the practice software system.

Conclusion: Although the software tool was regarded as helpful by the participating GPs and increased their awareness of medication safety, the number of inappropriate prescriptions in patients with renal impairment did not decrease significantly. Possible reasons for this result will be discussed.