gms | German Medical Science

Context: It is assumed that with increasing polypharmacy, the surveillance of the medication by the General Practitioner (GP) and the adherence to the therapy regimen by the patient will decline.

Aim of the study: In a cohort of 100 diabetic patients (47 f, 53 m, median age 70 years, range 39 to 91) with 3 or more chronic prescriptions, we evaluated clinical and medication records taken from the GP documentation. Patients were asked about their actual medication and its tolerability by a structured telephone interview.

Results: 45% of the patients had up 6 medications, 36% had 7 to 9 and 19% had > 10 medications. Main co-morbidity was hypertension (93%) and symptomatic CAD (39%). We found appropriate use of established medications for these co-morbidities, but only 67% of patients eligible for statin therapy actually took a statin, 46% of these in a dose < DDD. 68% of the patients took no other than the prescriptions recorded in the GP documentation, 17% took 1 prescription, 9% 2 prescriptions and 7% >2 prescriptions which were not found in the GP documentation. In 62% patients, all medication prescribed by the GP were actually taken, but 19% had 1 medication, 9% 2 medications and 6% >2 medications which were prescribed by the GP but not taken by the patient. In 16%, incompatible medications (defined according a consented list) were taken by the patient. 82% of the patients had regularly (twice per year) controls of HbA1c, but only 66% had controls of potassium, despite the use of ACI and diuretics. Most patients knew the reason for taking a drug for at least one medication, but 18% had this knowledge only for less of half of their (multiple) medications. 70% of the patients quoted that they had been informed about possible risks of their medication by the GP, and only 7% gave at least one quotation of a risk known to the patient. In 15% an ADR was suspected after evaluation of the telephone interview. However, almost all patients declared satisfaction with their current medication.

Conclusion: In this cohort of patients with polypharmacy and high risk profile for adverse drug reaction, we found mismatch between GP documentation of prescriptions and medication declared by the patient. There is no thorough knowledge about indication and almost no knowledge about risks. Although the overall performance of therapy (appropriateness) is sufficient and obviously patients were satisfied, there seems room for improvement to fill information gaps and strive for a tougher surveillance.