gms | German Medical Science

16th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

19.11. - 20.11.2009, Berlin

Appropriate dosing of drugs necessitating adjustment in patients with impaired renal function before and after an implementation of dose guidelines and an face-to-face educational intervention

Meeting Abstract

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  • Sascha Baum - Institut für Klinische Pharmakologie, Universitätsklinik Frankfurt am Main, Germany
  • corresponding author Sebastian Harder - Institut für Klinische Pharmakologie, Universitätsklinik Frankfurt am Main, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 16. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Berlin, 19.-20.11.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09gaa07

DOI: 10.3205/09gaa07, URN: urn:nbn:de:0183-09gaa075

Published: November 5, 2009

© 2009 Baum et al.
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Outline

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Background and aim: Whereas in larger hospitals individualized dose adjustment in renal insufficiency can be provided by expert systems and pharmacists, these options are often not available in smaller hospitals. We evaluated whether one short educational session for the medical staff of internal wards of a community hospital, focusing on creatinine clearance and dosing in renal insufficiency, and providing a list of frequently used drugs and their dosing schedule does reduce the rate of patients with unadjusted doses.

Material and method: In patients with a creatinine clearance <60ml/min, dosing schedules for 92 drugs were determined. After a 6-month observation period (cohort 1), an educational intervention and the abovementioned list were delivered to the medical staff. This intervention was followed by a further 6-months observation period (cohort 2).

Results: In cohort 1, 55/85 patients (median age 79y) had at least one initially inappropriately adjusted medication, and 47/85 remained so at discharge, whereas in cohort 2 (median age 77y), 28/85 patients had at least one initially inappropriately adjusted medication (p=0.014 compared to cohort 1) and 27/85 remained so at discharge (p=0.05). The total number of prescriptions in cohort 1 from the list of scrutiny (92 drugs most frequently used on the wards) was 319 (day 2 after admittance) and 341 (at discharge), in cohort 2, these numbers were 314 and 328, respectively. In cohort 1, 54.5% of all initial prescriptions of a drug for which adjustment is advised (N=202) followed an unadjusted dosage, this rate was 45.9% (from 220 prescriptions) at discharge. After the intervention (cohort 2), 26.8% of all initial prescriptions with a drug for which adjustment is advised (N=164) followed an unadjusted dosage (p<0.001 compared to cohort 1), this rate was 25.6% (from 176 prescriptions) at discharge (p<0.001 compared to cohort 1). No trend of fading of the interventions success was seen within the 6 months observation period after the intervention.

Conclusions: This intervention was on a „low key“-level, and no further support e.g. academic detailing was effected. Despite this, we found a considerable reduction in the use of critical drugs and the number of inappropriate doses in patients with impaired renal function.