gms | German Medical Science

Introduction: Due to the physiological changes caused by the process of aging as well as the frequently taken recourse to polypharmacy, AMTS among elderly (and especially multimorbid) patients is a subject that requires for its proper assessment the taking into account of a variety of important factors.

In a first observation it is possible to identify as such factors e.g. the risk of falling connected with the use of certain pharmaceuticals, over dosages, a lack of indications and an insufficient or incorrect treatment. All of these factors have in common that they are not only imposing considerable costs but also limit to a significant degree the QL of the concerned patients due to the connected psychological and physical burdens.

Besides these above-mentioned factors it is furthermore possible to identify the diligent observation of symptoms as a crucial prerequisite for the successful medication of a patient. This point is thus of specific importance to caregivers since one of their main tasks entails the observation of patients as well as subsequently communicating their findings to the concerned physicians in a qualified manner.

It is for these reasons that Hanke and Füsgen [1] focus in their “Geriatric Medication Assessment” (GMA) on the subjects of patient empowering, pharmacotherapy and organisation in order to thus shift the actual medication process into the focus of the parties involved.

Methods: In order to realise a time efficient application of the GMA a sequential analysis was incorporated into a database customized for this purpose. This approach enables geriatric pharmacists to take into consideration not only medication data but also information related to the diagnosis and laboratory findings as well as current causes of complaints from the patient himself. Following this approach assures that the general order of the sequential analysis will be adhered to at any time. This holds particularly true with regards to tracking factors such as indication, dosage, PIM, UAW (which can also be observed and evaluated by caregivers), interactions and costs related to therapy. Following this analysis a medication proposal will be created which, among other things, may provide for reasoned suggestions concerning modifications and the re-evaluation of therapy costs. The patients themselves also benefit from the handing out of printed dosage schemes which appropriately illustrate information concerning medication, dosage and offer easily understandable instructions concerning the application.

Results: A first analysis revealed the existence of genuine opportunities to improve geriatric medications. It was possible to consider the essential elements of GMA.

In order to enable caregivers to observe symptoms of patients in a qualified manner and to thus effectively incorporate them into the medication process it is proposed to utilize a “knowledge-based” medication form.

Discussion and conclusion: In order to increase the reliability of collected data one should consider introducing a system of peer-review.