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

Medication review of patients community-dwelling seniors using high-level homecare service

Meeting Abstract

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  • M. Ermer - 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. Doc09gaa17

DOI: 10.3205/09gaa17, URN: urn:nbn:de:0183-09gaa179

Published: November 5, 2009

© 2009 Ermer et al.
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Outline

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Background and aim: Investigations on polypharmacy and problems arising from polypharmacy (e.g. medication burden, falling, and inappropriate dosing in renal impairment) in functionally impaired or disabled patients have been obtained in patients living in residential care homes and nursing homes. Data from home-dwelling patients in high-level ambulatory care (one or more daily visits by a care-giver) a scant. Usually, the medication of these patients is prescribed by general practitioner, but administered and supervised by the care-giving nurse, and the patient is seen by the GP less frequently than a mobile patient.

Material and method: In an observational study (March 2008–March 2009), we evaluated the medication in a cohort of patients who were daily visited by an ambulatory care giver (site: Wiesbaden). The cohort consisted of 102 patients (72 w; 30 m; age 80 y (median, range 52–93y), most frequent diagnoses: hypertension [N=63], coronary artery disease [N=57], hyperlipidemia [N=37], diabetes mellitus [N=25], chronic heart failure [N=23]). We documented data on diagnoses, occurrence of falls, laboratory values obtained by the general practitioner, chronic medication and medication used at demand at altogether 3 visits (V1, V2, V3) at intervals of 4 months, data were taken from the GP records (laboratory) or the medical records available to the care-giving nurse.

Results: The medication burden increased slightly within one year, at V1 patients had 5 chronic prescriptions (median, range 3– 15), at V3 6 (3–17) medications were prescribed. A total of 8 daily doses (median, range 3–21) were given at V1 and increased to 8.5 (4–25) at V3. Within one year, 2 (median, range 0-21) changes in the medication (discontinuation, newly added medications) have occurred; 15% of all prescriptions at V1 have been discontinued and most replaced by a new medication. At V2, 41/102 patients had their serum creatinine measured within the last year, 21 of these 41 patients had a GFR <50 ml/min (calculated according Cockroft & Gault formula), these 21 patients had 52 medications which need adjustment in renal impairment, from these 52 medications 18 were not appropriately adjusted. At V3, in 13 of 33 patients with a GFR <50 ml/min altogether 6 of 31 medications which need adjustment were not adjusted. Within one year, 29 of 102 patients had at least one falling event (total 38 falls), 20 patients had been either admitted to the hospital or visited by an emergency doctor. 18 of these 29 patients had a benzodiazepine prescribed regularly, whereas in 46 patients which were not immobilized and did not fall have, a benzodiazepine was prescribed in 6 cases (x2-test p = 0.004).

Conclusions: This survey in home dwelling patients requiring high-level care proves a high medication burden, reflecting the morbidity spectrum of these patients. Deficits have been detected in the surveillance of the medication (infrequent and scant control of creatinine), and an association between benzodiazepine prescriptions and falls can be demonstrated.